Acute cholecystitis with incidental hepatic haemangioma

Case contributed by Dr Henry Knipe

Presentation

Epigastric abdominal pain.

Patient Data

Age: 50 years
Gender: Male

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 haemangiomas.

The patient was treated with intravenous antibiotics initially with a delayed cholecystectomy six weeks later. 

Histopathology

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.

Case Discussion

Classic ultrasound findings of acute cholecystitis with cholelithiasis, gallbladder wall thickening and pericholecystic fluid. Key to this case is also recognising the incidental liver findings, with haemangiomas the most likely diagnosis. 

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Case information

rID: 46322
Case created: 30th Jun 2016
Last edited: 13th Jul 2017
Inclusion in quiz mode: Included

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