Presentation
RUQ pain and deranged LFTs.
Patient Data
The gallbladder is markedly distended with irregular wall thickening and pericholecystic fat stranding. The fundus distorts the anterior abdominal wall musculature (tensile gallbladder fundus sign). No calculus is identified. No intra or extrahepatic bile duct dilatation. The liver parenchyma surrounding the gallbladder demonstrates slight increase in attenuation which is likely reactive.
The spleen, kidneys, adrenal glands and pancreas are normal.
Portal vein is clear. Major arteries are unremarkable.
No free fluid or free gas. No lymphadenopathy.
Impression
CT findings of acute cholecystitis. No evidence of calculus or bile duct dilatation.
Case Discussion
Laparoscopic cholecystectomy was performed uneventfully and histology confirmed acute cholecystitis.
This case demonstrates the tensile gallbladder fundus sign, where the distended gallbladder fundus bulges into and distorts the anterior abdominal wall. The gallbladder distension is due to acute cholecystitis.