Presentation
10 days history of right upper abdominal pain, fever and tenderness. Known hypertensive patient.
Patient Data
Distended gallbladder with a thick enhancing wall. A focal defect of the gallbladder wall is noted communicating with a peri-and subhepatic fluid collection with surrounding mesenteric fat stranding and thickening with enhancement of the adjacent peritoneal reflections. Minimal effusion is noted in the pelvic region.
Other findings:
generalized left renal atrophy and left renal artery stenosis (known hypertensive patient)
arteriosclerosis of the abdominal aorta and iliac arteries
sliding hiatal hernia
colonic diverticula mainly of the sigmoid colon
small umbilical hernia
degenerative disc disease at L5-S1
Annotated images: the yellow arrows indicate the site of gallbladder perforation
Case Discussion
CT features of perforated acute cholecystitis with peri/subhepatic fluid collection and focal peritonitis that was confirmed at surgery.
An ultrasound exam (not shown) was performed after CT scan revealed small gallstones.
Left renal artery stenosis is an important incidental finding.
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