Acute complicated calculous cholecystitis
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Presentation
Febrile illness followed by right upper abdominal pain.
Patient Data
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 images depicting the above findings.
Image 1: Pericholecystic free fluid
Image 2: Differential hepatic attenuation
Image 3: Anterior segment right portal vein bland thrombus
Image 4: Radiodense gall stone
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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