Presentation
Right upper quadrant pain.
Patient Data
There are numerous gallstones, without gallbladder dilatation.
Non-obstructive stone in the distal common bile duct.
Hepatomegaly and steatohepatitis.
Cystic lesion in the pancreatic body measuring 12 mm.
Hypodense splenic lesion in keeping with a splenic cyst with a more superior hypervascular splenic nodule suggestive of splenic haemangioma.
Right adrenal adenoma. Colonic diverticulosis.
MRCP confirms the presence of gallstones in the distal common bile duct.
There is no dilatation of the biliary ducts.
The patient presents for recurrence of the right upper quadrant pain.
Onset of a new subhepatic lesion, adjacent to segment VI, measuring 18 mm, presenting central calcifications and peripheral enhancement. Mild fat stranding adjacent to this lesion.
Stability of the pancreatic and splenic cyst. Stability of the splenic haemangioma and of the right adrenal adenoma.
No dilatation of the main pancreatic duct. The biliary ducts are unremarkable.
Colonic diverticulosis.
MRI for the characterisation of the subhepatic lesion.
The subhepatic lesion, adjacent to segment VI, is hypointense on T1, an intermediate signal on T2, and hyperintense on DWI with peripheral enhancement after gadolinium injection, measuring 18 x 14 mm.
The lesion size is stable, a 3-month follow-up was advised.
Increased size of the enhancing subhepatic lesion adjacent to segment VI, measuring 31 x 20 mm (vs 18 x 14 mm).
Onset of a retraction of the lateral abdominal and colonic wall towards the lesion.
Case Discussion
The absence of this lesion prior to cholecystectomy, its location, and its aspect on CT are highly suggestive of an inflammatory granuloma around foreign bodies, most likely dropped gallstones from previous laparoscopic cholecystectomy. The enhancement and retraction observed on MRI are falsely worrisome and correspond to the local inflammation.
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