Ceftriaxone-associated gallbladder pseudolithiasis

Case contributed by Yaïr Glick

Presentation

Fever, abdominal pain.

Patient Data

Age: 8 years
Gender: Female

Normal-appearing non-distended gallbladder with thin walls, containing anechoic bile.

10 days later

ultrasound

The partially contracted gallbladder now contains hyperechoic sediment that does not cast an acoustic shadow.

Case Discussion

The girl had been running a fever for 10 days and complained of abdominal pain. She had been started on ceftriaxone by her treating physician. All in all, received ceftriaxone for 10 days while started concurrently on a regimen of additional antibiotics (e.g. metronidazole) at the hospital.

The first ultrasound study showed a normal gallbladder (and thickened small bowel and colonic walls; not shown), while the second study showed a newly-appeared markedly hyperechoic sediment in the gallbladder. The hyperechoic sediment can be attributed to ceftriaxone, which contains calcium, a large proportion of which is concentrated in the gallbladder.

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