Presentation
Confirmed pancreatitis with elevated lipase levels and epigastric pain. Ultrasound to rule out cholelithiasis.
Patient Data
Dilatation with a heterogenous mass/content in the gallbladder. This lesion is not hypervascular but there seems to be a focal flow in the superior aspect of the gallbladder.
Dilated gallbladder (50 mm in diameter) with a non-enhancing hyperdense content in keeping with hemobilia and hematoma.
Fat stranding around the gallbladder with mild peritoneal fluid.
Focal oval-shaped arterially-enhancing lesion arising from the superior branch of the cystic artery.
No active extravasaton of contrast.
The common bile duct is dilated (11 mm) with a hyperdense content (hemobilia).
Gallbladder wall thickening, hyperemia, mild peritoneal fluid, and pericholecystic fat stranding, in keeping with cholecystitis.
Mild dilatation of the intrahepatic bile ducts with periportal edema.
Fatty degenration of the pancreas with no peripancreatic fluid or collection. There is no pancreatic lesion or main pancreatic duct dilatation.
Case Discussion
This case illustrates how challenging it is to differentiate hematoma and neoplastic lesions on ultrasound. There was flow in the superior aspect of the lesion but was not specific for pseudo-aneurysm, even if the pulsed Doppler demonstrated arterial flow.
This pseudo-aneurysm is most likely due to cholecystitis since the inflammation markers were elevated.
Pancreatitis in this case is due to hemobilia and acute obstruction of the main pancreatic duct. There were no CT features of pancreatitis (mCTSI 0) because the CT was made too early (< 48h-72h).
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