Acute calcular cholecystitis

Case contributed by Dr Mohammad Taghi Niknejad

Presentation

Abdominal pain and vomiting.

Patient Data

Age: 50 years
Gender: Female

The gallbladder is markedly distended up to 75 mm and shows increased wall thickness and enhancement; accompanied by pericholecystic inflammatory fat stranding. Multiple small low signal filling defects are seen in gallbladder inferring stones. An impacted stone is also observed at the cystic duct.

Extra and central intrahepatic bile ducts are dilated and CBD measured 11 mm in caliber with homogeneous internal signal intensity and abrupt distal cut-off.

A 25 mm midline fascial defect is present at the anterior abdominal wall that some omental fat herniated through it.

Case Discussion

Features on MRI are compatible with acute cholecystitis with impacted stones at the cystic duct. Impacted distal CBD stone is also suspected.

MRI is sensitive in the detection of acute cholecystitis, with findings similar to those seen on ultrasound and CT. MR cholangiopancreatography (MRCP) may show an impacted stone in the gallbladder neck or cystic duct as a rounded filling defect.

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