Subacute pericholecystic abscess

Case contributed by Dr Jayanth Keshavamurthy


Chronic recurrent right upper quadrant pain abdomen in a veteran.

Patient Data

Age: 65 years
Gender: Male
Nuclear medicine

Metabolically active gallbladder with gallstone and recommend ultrasound/hepatobiliary scan to evaluate for acute on chronic calculous cholecystitis.

The gallstone has moved from the neck to the fundus of the gallbladder. The mass does not move and so a metabolically active focal gallbladder lesion likely that is inflammatory in nature.

10 months prior


10 months prior to PET C, the large gallstone was in the neck of the gallbladder.

3 weeks after PET CT


There is a large gallstone, thickened and ill-defined gallbladder wall. This study is 3 weeks after the PET CT. There is a small pericholecystic fluid collection adjacent to the gallbladder and liver.

After ultrasound


MRCP showing large stone in the neck of the gall bladder. There is a fluid collection adjacent to the gallbladder - likely a tiny rupture with pericholecystic fluid collection and abscess. No choledocholithiasis.

Case Discussion

The patient underwent laparoscopic surgical cholecystectomy confirming a pericholecystic abscess, extensive adhesions, chronic cholecystitis with mucosal erosions. JP drain was left in place. He was discharged home on antibiotics postoperatively. Do not take comfort that a large gallstone will not cause trouble.

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