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Persistent right umbilical vein (PRUV) is a vascular pathology in which the left umbilical vein becomes occluded while the right umbilical vein persists and remains open. When observing fetal anatomy during a routine 18-week scan, it is important to notice the direction of the vasculature for possible fetal anomalies such as PRUV. In this case, a full detailed sonogram of the fetus was conducted and an extrahepatic PRUV was observed using 2D imaging and further confirmed using color Doppler to identify the type of PRUV. Following the identification of the PRUV, the fetus was thoroughly assessed for the possibility of other associated anomalies. Clearly, when an anomaly is observed, it is crucial to assess the fetus for associated congenital variances to identify risk and potential outcome.

Three cases of persistent right umbilical vein associated with left-sided gallbladder are presented. This poorly understood, rare variant is due to obliteration of the left umbilical vein during embryonic development. The left-sided gallbladder, associated with persistent right umbilical vein, is not anomalous positioning of the gallbladder but an embryologic abnormality of the umbilical vein that causes the gallbladder to migrate to the left of the ligament teres. Findings and clinical relevance are discussed.