Presentation
Acute-on-chronic abdominal pain ?perforated viscus.
Patient Data
The gallbladder is abnormal with thickening of the wall and pericholecystic stranding.
Within the neck of the gallbladder there is a hyperdense rounded structure measuring 10 mm, likely a stone impacted within the neck of the gallbladder.
There is a small amount of free intraperitoneal fluid around the right paracolic gutter extending down into the pelvis.
There is dilation of the large bowel with the bowel measuring up to 6.5 cm. This is presumed secondary to an ileus. The small bowel has a normal appearance.
Within the tail of the pancreas there is a rounded 1 cm enhancing lesion which is isodense to spleen. However, the lesion appears to involve more of the tail of the pancreas rather than the hilum of the spleen. Although this may represent a splenunculus, a lesion within the tail of the pancreas cannot be excluded.
Conclusion:
- findings are in keeping with acute cholecystitis
- rounded lesion within the tail of the pancreas which may represent a mass; alternatively this may represent a splenunculus; dedicated pancreatic imaging is suggested
Case Discussion
Patient proceeded to cholecystectomy. Histology confirmed acute hemorrhagic cholecystitis and cholelithiasis.
While the findings are fairly obvious in this case, it is important to remember to assess the gallbladder on CT even though US is more commonly used for the diagnosis of cholecystitis.
Unable to process the form. Check for errors and try again.