Age: 40
Sex: Female
Indication: Right-sided abdominal pain
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Case #45
Findings
- Lower chest
- Mild dependent right basilar atelectasis
- Abdomen/Pelvis
- Gallbladder wall thickening and enhancement with mural discontinuity along the ventral margin near the fundus with a contiguous large multiloculated, peripherally-enhancing collection measuring 13 x 8 x 16 cm in the right hepatic lobe involving segments 5 and 6
- Multiple rounded peripherally hyperdense structures in the gallbladder and in the dependent aspect of the hepatic collection consistent with gallstones
- 1.7 cm hypodense lesion in segment 2 of the liver with possible discontinuous peripheral enhancement
- Mild intrahepatic biliary duct dilation
- Small volume free fluid layering in the anatomic pelvis
- MSK
- No acute findings
Diagnosis
- Perforated acute cholecystitis with hepatic abscess
Sample Report
Findings consistent with perforated acute cholecystitis with a large contiguous right hepatic abscess. Recommend surgical evaluation.
Mild intrahepatic biliary duct dilation likely resulting from mass effect from the large hepatic abscess on the hepatic hilum.
Hypodense structure in the left hepatic lobe may represent a hemangioma or less likely a satellite abscess. This could be further evaluated with ultrasound.
Discussion
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References
- Bächler P, Baladron MJ, Menias C, Beddings I, Loch R, Zalaquett E, Vargas M, Connolly S, Bhalla S, Huete A. Multimodality imaging of liver infections: differential diagnosis and potential pitfalls. Radiographics 2016; 36(4): 1001-1023.
- O’Connor OJ, Maher MM. Imaging of cholecystitis. AJR Am J Roentgenol 2011; 196(4): W367-W374.
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