Whilst the classic signs of acute cholecystitis can be detected on CT, it is less sensitive than ultrasound, and ultrasound is the first line modality to detect gallstones. An MRI done 2 days later confirmed multiple stones in the gallbladder but no obstructing duct stones. After an uneventful recovery, elective cholecystectomy was performed 4 months later.

Macroscopic: Gallbladder 80 x 35mm containing bile and multiple small stones with a wall thickness of 2mm.

Microscopic: This gallbladder shows moderate fibromuscular thickening of its wall with mild chronic inflammation and occasional Rokitansky-Aschoff sinuses. There is no dysplasia or malignancy. 

Conclusion: Gallbladder - chronic cholecystitis and cholelithiasis.

It is important to report the left sided IVC (also known as transposed IVC) as it has implications for future surgical and interventional radiology procedures. It is the most common of the IVC anomalies.