Acute cholecystitis complicated with hepatic abscess

Case contributed by Mostafa Elfeky
Diagnosis probable

Presentation

Right hypochondrial pain and jaundice

Patient Data

Age: 45 years
Gender: Male

Impacted gallstone at gallbladder antrum with diffuse wall thickening, edema and perifocal fat stranding, in keeping with acute cholecystitis. Few other gallstones are noted at the gallbladder fundus. Thickening of right Gerota fascia and perihepatic peritoneal reflections are also noted.

Rounded hypodense lesion is noted at segment VI of the liver with homogeneous hypodense non-enhancing core and double target appearance consisting of enhancing inner wall and hypodense outer wall that enhances only in delayed phase representing edema. Features are in keeping with hepatic abscess.

Case Discussion

Hepatic abscess complicating acute cholecystitis is rare yet a serious complication. It can be due to intrahepatic perforation of the gallbladder or without direct connection to the gallbladder (synchronous hepatic abscess), but both occur mainly at lower hepatic segments. 

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