Presentation
Right hypochondrial pain
Patient Data
Moderate diffuse enhancing thickening of gallbladder wall having maximum thickness ~10 mm, mildly infiltrating into adjacent liver parenchyma in segment 5/6. The gallbladder is adherent to the hepatic flexure of the large bowel and the second part of the duodenum with mild to moderate surrounding inflammatory changes. Multiple small hyperdense calculi in the gallbladder lumen. A few small hypodense non-enhancing areas in the thickened gallbladder wall have tiny fat attenuation at places.
A mildly enlarged discrete enhancing lymph node of size ~1.7 x 1.4 cm in the periportal region with no evidence of necrosis or calcification within it.
Impression: Xanthogranulomatous cholecystitis is the likely diagnosis. Other less likely differential diagnoses include neoplastic gallbladder wall thickening (histopathological correlation is suggested).
Annotated image showing fat attenuation in the gallbladder wall.
Case Discussion
The patient went for an open cholecystectomy with a frozen section intraoperatively. The frozen section revealed acute on chronic cholecystitis. The pathology report of the gross specimen revealed xanthogranulomatous calculous cholecystitis.
Co-author: Dr Sanjoy Kumar (GI surgeon).
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