Presentation
Obstructive jaundice, fever, right hypochondrial pain.
Patient Data
The gallbladder is distended harboring biliary sludge as well as two stones, measuring 1.5 cm each. One of them is located in the gallbladder neck, exerting extrinsic compression on the biliary confluence, with moderate diffuse intrahepatic biliary duct dilatation (Mirizzi syndrome).
A 6.8 cm lesion is noted at segments IV/VIII, showing T2 hyperintensity and rim enhancement with surrounding hepatic hyperemia, and no central enhancement (hepatic cholangitic abscess).
The gall bladder neck stone is compressed within the biliary confluence and proximal CBD, with moderate diffuse intrahepatic biliary dilatation (Mirizzi Syndrome).
Case Discussion
Imaging features of this case are in keeping with calculous cholecystitis, with Mirizzi syndrome and hepatic abscess present. Low insertion of the cystic duct into the common bile duct is thought to be an anatomical risk factor. Mirizzi syndrome could be associated with recurrent cholangitis and in turn, the possibility of cholangitic abscess formation.