Acute cholecystitis - CT

Case contributed by Dr Michael P Hartung

Presentation

Abdominal pain.

Patient Data

Age: 65 years
Gender: Male
CT

Dilated, thick-walled gallbladder with surrounding fat stranding and reactive hepatic flexure inflammation. Chronic aortoiliac dissection. Fat containing left inguinal hernia. Borderline periaortic lymph nodes (chronic).

Case Discussion

Typical findings of acute cholecystitis on CT include a dilated, thick-walled gallbladder, inflammation/stranding of the surrounding fat, and (often very helpful) reactive inflammation of the hepatic flexure. It can also indent the body wall (referred to as the tensile fundus sign). Notice how CT is superior to US for this evaluation because it can detect pericholecystic inflammation (stranding) and inflammation of the colon, both of which cannot be reliable seen with ultrasound. 

This patient underwent cholecystectomy where they found the gallbladder adhered to the colon, resulting in a challenging subtotal resection of the gallbladder (indicating a subacute presentation). 

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