Perforated calculous cholecystitis with resultant subcapsular liver abscess
Diagnosis certain
Presentation
RUQ pain, elevated inflammatory markers. US showed distended gallbladder with foci of gas, and inhomogeneous perihepatic collection of fluid.
Patient Data
Age: 80 years
Gender: Male
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Noncontrast scan due to severely impaired renal function:
- Large, intermediate density subcapsular fluid collection around the liver with significant amount of dependent gas, compressing the liver.
- The collection is communicating with the distended, perforated gallbladder, which also contains gas and small gallstones, also showing wall irregularity.
- Moderate amount of gas in the intrahepatic bile ducts, and periportal congestion.
- Spleen enlarged with a length measuring 160 mm.
- Moderately enlarged prostate.
- Several foci of lytic bone destruction in the depicted skeleton and resultant compression of multiple vertebral bodies. Findings are consequence of known multiple myeloma.
Case Discussion
The patient went under US-guided drainage, and E. Coli was cultured from the fluid aspirated from the subcapsular abscess.
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