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Age: 72

Sex: Male

Indication: Right upper quadrant pain

Sonographic Murphy sign: Positive

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Case #7


Findings

  • Gallbladder is distended with marked wall thickening, pericholecystic edema, and multiple layering gallstones
  • Focal apparent mural discontinuity at the gallbladder fundus
  • No intrahepatic or extrahepatic biliary duct dilation
  • Hyperechoic filling defect in the left portal vein with absence of flow on color Doppler evaluation
  • Normal appearance of the liver, spleen, kidneys, and urinary bladder
  • Visualized portion of the pancreas appears normal
  • Visualized segments of the abdominal aorta are normal in caliber


Diagnosis

Gangrenous acute cholecystitis

Portal vein thrombosis

Sample Report

Gallbladder distension, marked wall thickening, pericholecystic edema, multiple layering gallstones, and positive sonographic Murphy sign, consistent with acute cholecystitis. Focal apparent mural discontinuity at the gallbladder fundus is concerning for gangrenous change.

No intrahepatic or extrahepatic biliary duct dilation.

Left portal vein thrombosis. Consider contrast-enhanced CT for further assessment.


Discussion

  • When evaluating cases of acute cholecystitis, make sure to assess for complications including evidence of gangrene (including striated appearance of the gallbladder wall, wall discontinuity, and gas in the gallbladder wall), pericholecystic or hepatic abscess, and venous thrombosis
  • Make sure to always assess the biliary tree because it is important for the surgeon to know if there is concomitant biliary obstruction, either resulting from calculi in the common bile duct or from a gallstone in the cystic duct exerting mass effect on the adjacent common hepatic duct (Mirizzi syndrome)


Images

Focal mural discontinuity at the gallbladder fundus (red arrow) concerning for gangrenous change.

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