Acute cholecystitis and incidental left sided IVC

Case contributed by Vikas Shah
Diagnosis almost certain


Severe abdominal pain and vomiting. Tender on right side, with guarding. Surgeons felt it was unlikely he would tolerate ultrasound examination.

Patient Data

Age: 45 years
Gender: Male

The gall bladder is thick-walled with abnormal enhancement of the wall and is surrounded by a thin rim of free fluid. There is no biliary dilatation or liver lesion.

There is a left sided IVC but no other vascular anomaly or abnormality.
Righ total hip replacement with old right iliac fracture.

No other significant abnormality.

Case Discussion

Whilst the classic signs of acute cholecystitis can be detected on CT, it is less sensitive than ultrasound, and ultrasound is the first line modality to detect gallstones. An MRI done 2 days later confirmed multiple stones in the gallbladder but no obstructing duct stones. After an uneventful recovery, elective cholecystectomy was performed 4 months later.

Macroscopic: Gallbladder 80 x 35mm containing bile and multiple small stones with a wall thickness of 2mm.

Microscopic: This gallbladder shows moderate fibromuscular thickening of its wall with mild chronic inflammation and occasional Rokitansky-Aschoff sinuses. There is no dysplasia or malignancy. 

Conclusion: Gallbladder - chronic cholecystitis and cholelithiasis.


It is important to report the left sided IVC (also known as transposed IVC) as it has implications for future surgical and interventional radiology procedures. It is the most common of the IVC anomalies.

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