Presentation
Acute right upper abdominal pain, fever. clinically suspected perforated duodenal ulcer.
Patient Data
Mild hepatomegaly with hepatic periportal oedema.
Thickened oedematous gallbladder wall with hyper-enhanced mucosa and pericholecystic oedema and fluid.
Mild intraperitoneal free fluid collection is mainly seen at the pelvic recesses.
No oral contrast leakage.
Diffusely blurred oedematous intra-abdominal fat planes.
An ovoid, blurred fat-density lesion centred on the falciform ligament with a dense wall and central dot/ central line suggestive of appendagitis of the falciform ligament.
Case Discussion
Imaging has a crucial role in differentiating medical from surgical acute abdominal cases. This patient lab showed elevated liver enzymes, elevated bilirubin and reactive hepatitis A virus antibodies IGM confirming the diagnosis of acute viral hepatitis A.
Falciform ligament appendagitis can be isolated primary or secondary to inflammatory conditions of other adjacent organs as seen in this case 1.
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