Acute complicated calculous cholecystitis

Case contributed by Dr Varun Babu

Presentation

Febrile illness followed by right upper abdominal pain.

Patient Data

Age: 40 years
Gender: Male

Features of active gall bladder inflammation in the form of circumferential mural thickening, mural hyperenhancement, mild pericholecystic free fluid and dependent multiple <3 mm calculi. 

Filling defect seen in anterior branch of right portal vein. Secondary differential hepatic attenuation of segment V and VIII. Rest of the portal system, the hepatic arterial and venous systems are patent. 

Annotated image

Annotated images depicting the above findings.

Case Discussion

This is an uncommon case of acute calcular cholecystitis getting complicated by segmental portal venous thrombosis. Cholecystitis being a hypercoagulable state, disseminated intravascular coagulation may occur and should be looked out for. 

The differential segmental hepatic attenuation is due to the post thrombotic increased hepatic arterial flow to segments V and VIII. 

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Case information

rID: 55202
Case created: 25th Aug 2017
Last edited: 25th Aug 2017
Inclusion in quiz mode: Included
Institution: Vivid Diagnostic Centre

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