Right upper quadrant pain and elevated bilirubin.
US Abdomen (selected images)
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Gallbladder is distended and has thickened wall, measuring up to 6 mm. A focus of wall discontinuity is noted near the gallbladder fundus (IM: 54) and pericholecystic fluid is noted. Multiple gallstones identified and a stone is within the dilated cystic duct. No intrahepatic biliary dilatation. Common biliary duct is not abnormally distended. Liver has diffuse increased echogenicity in keeping with fatty infiltration. No hepatic focal lesions. Imaged pancreas has normal sonographic appearances.
Gallbladder perforation is an uncommon complication related with cholecystitis. This diagnosis was achieved based on the clinically and sonographic features of acute cholecystitis, with the presence of pericholecystic fluid and subtle layering of the gallbladder wall with a well-defined focus of wall discontinuity.