Acute cholecystitis with incidental hepatic hemangioma
Epigastric abdominal pain.
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Cholelithiasis. Gallbladder wall thickening with pericholecystic free fluid. CBD measures 5 mm.
Echogenic lesions measuring a maximum of 2.4 cm of within the left lateral liver segment most consistent with hemangiomas.
The patient was treated with intravenous antibiotics initially with a delayed cholecystectomy six weeks later.
MACROSCOPIC DESCRIPTION:"Gallbladder": A previously opened gallbladder 70x25x22mm, containing numerous lobulated firm yellow calculi up to 5mm. The mucosa is velvety green, the wall is up to 7mm and the serosa is shiny and smooth. P1.
MICROSCOPIC DESCRIPTION: There are a few Rokitansky Aschoff sinuses in the gallbladder wall. The mucosa is autolysed. The intact epithelium shows no dysplasia. There is a light transmural chronic cell infiltrate and fibrous tissue is increased. There is no evidence of malignancy.
DIAGNOSIS: Gallbladder: Cholelithiasis and mild chronic cholecystitis.
Classic ultrasound findings of acute cholecystitis with cholelithiasis, gallbladder wall thickening and pericholecystic fluid. Key to this case is also recognizing the incidental liver findings, with hemangiomas the most likely diagnosis.