IMPORTANT: We currently have a number of bugs related to image cropping and are actively trying to resolve them. In the meantime, we have disabled cropping. Apologies for any inconvenience. Stay informed: radiopaedia.org/chat

Traumatic gallbladder hemorrhage

Case contributed by Luu Hanh
Diagnosis almost certain

Presentation

Acute onset right upper quadrant abdominal pain after motor vehicle accident. Unremarkable history.

Patient Data

Age: 45 years
Gender: Male
ultrasound

US shows dependent, layered hyperechoic material showing greater echogenicity than typical sludge.   

CT shows hyperdense material within the gallbladder lumen (64HU) in NECT

Intraperitoneal free fluid in the recto-vesical pouch and surrounding the liver.

22 hours later

ct

On the follow-up study, hyperdense material within the gallbladder lumen has increased in size.

The gallbladder wall is enhancing and intact.

Free fluid in the gallbladder fossa, the minor contusion of the adjacent liver is also seen.

Blood test:

RBC : 3,86 G/l ; HGB: 90 g/l

GOT: 200 U/l ; GPT: 50 U/l ; Creatinin 65 µmol/l

Ethanol : 182 mg/100ml

Case Discussion

The causes of high-density bile consist of vicarious contrast excretionmilk-of-calcium bile, gallbladder hemorrhage. The vicarious contrast excretion and milk-of-calcium bile do not generally appear as echogenic at US, nor is a fluid-fluid level observed 2. Eventually, the delayed phase CT is the clue to the diagnosis. In the traumatic gallbladder, delayed images will show an increased size of dense material within the gallbladder because the hemorrhage is progressing. In contrast, the nontraumatic gallbladder will remain stable 1.

This patient had normal renal function and no contraindication against injecting a high dose of contrast. Therefore, on the follow-up study, increased size hyperdense material within the gallbladder lumen is suggestive of progressing hemorrhage .

In the traumatic setting, US and CT findings are consistent with traumatic gallbladder hemorrhage. This case can be classified as grade II according to the AAST injury scoring scales (table 9) 3.

 

How to use cases

You can use Radiopaedia cases in a variety of ways to help you learn and teach.

Creating your own cases is easy.

Updating… Please wait.

 Unable to process the form. Check for errors and try again.

 Thank you for updating your details.