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The incidence of congenital bilobed gall bladder is 1 in 3000 to 4000. When multiphase CT/MRI are inconclusive, cholescintigraphy may be critical in preventing an unnecessary cholecystectomy. 1 It is when the fundus of the gallbladder folds on itself and thus looks notched, resembling the caps worn by the ancient Phrygians of Anatolia (modern-day Turkey), figure 5 or liberty caps of the French revolution, or Smurf caps (figure 6). Interestingly, the terminology is coined from the resemblance of the gallbladder 'cap' deformity to a style of pointed hat seen in ancient Greek art.

Phrygian caps are the most common congenital anatomic variant of the gallbladder. A Phrygian cap may be identified on ultrasound, multiphase CT/MRI or May be wrongly interpreted as a septum in an otherwise normal gallbladder.Usually clearly differentiate Phrygian caps from mass lesions. The Greeks knew of the cap as an Oriental headgear that was tight fitting and conical in shape and it has been depicted in their art. A Phrygian cap gallbladder is a common congenital abnormality of the gallbladder, found in 2–6% of people in autopsies. A Phrygian cap is a congenital anomaly of the gallbladder with an incidence of 4%. It was first described by Bartel in 1916. The phrygian cap is the most interesting shape of the galbladder with a fascinating cultural history. {"url":"/signup-modal-props.json?lang=us\u0026email="}

The phrygian cap is a common normal variant of gallbladder shape characterized a fundus that is folded forward. 4% of the population have a gallbladder fundus that is folded on the body of the gallbladder and was named a phrygian cap by Bartel in 1916. The Phrygian cap is a conical cap or cap with a curved or anteriorly inclined top that was worn by the ancient Phrygians; it is called the "cap of freedom" (Oxford Dictionary of English). (The phrygian cap is a common normal variant of gallbladder shape characterized a fundus that is folded forward.

The artistic rendition above reflects the cap.

Delayed imaging demonstrates filling of the gallbladder ruling out an underlying mass lesion. It can simulate a mass in the liver during hepatobiliary imaging and is sometimes mistaken for pathology.

The Phrygians were a primitive race that migrated into northern and central Asia Minor in the second millenium BC. Cholecystectomy must be performed only when the deformed gallbladder causes symptoms like right upper quadrant abdominal pain … He used the Phrygian cap to hide his ears. It was first described by Bartel in 1916. The Phrygians were a primitive people that migrated to northern and central Asia Minor between 1000 and 2000BC.

Spech et al. (2).
Gall bladder with Phrygian cap deformity can lead to misdiagnosis of gall bladder stones or a mass in the liver during hepatobiliary imaging which may suggest a tumour. Preferred mode of diagnosis for Phrygian cap is … It was subsequently worn by the Trojan hero Paris, was a symbol of freedom in the French and American revolutions, was depicted on coinage in the US and on variety of seals and flags throughout the world.The cap was a symbol of freedom and the pursuit of liberty.

Discussion A Phrygian cap deformity of the gallbladder can occur in about 4% of the patients and is essentially the appearance that is created due to the folding of the fundus of the gallbladder on its body. As a benign anatomical variant, Phrygian caps should not be mistaken for a pathology and does not require treatment. The size of the fold and the cap is quite variable.82407b14.8s gallbladder Phrygian cap freedom liberty shape symbol Davidoff art Copyright 200804487.84s.8s gallbladder fundus fundal fold fold normal variant anatomy shape cystic duct phrygian cap Davidoff art copyright 200839696 39696b Courtesy Ashley Davidoff MD gallbladder normal anatomy shape phrygian cap45217 gallbladder shape phrygian cap normal anatomy shape USscan Courtesy Ashley Davidoff MD82028c.8s gallbladder shape Phrygian cap normal variant anatomy MRI T1 weighted image T2 weighted image out of phase Courtesy Ashley DAvidoff MD copyright 200804766b05b10.2k.8s gallbladder parts fundus = dark green body = green neck = light green normal anatomy Davidoff Art Copyright 200818260.8s gallbladder shape phrygian cap distended enlarged courtesy Ashley Davidoff MD copyright 200804487.8s gallbladder fundus fold normal variant anatomy shape OCG Courtesy Ashley DAvidoff MD copyright 2008
It was worn by King Midas who was cursed with donkey ears by Apollo. It was subsequently worn by the Trojan hero Paris, was a symbol of freedom in the French and American revolutions, was depicted on coinage in the US, and also depicted  on variety of seals and flags throughout the world. The gallbladder, as a result of a sharp inflection in the bottom, deforms in such a way that it resembles the so-called Phrygian cap.
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