Indication: Right upper quadrant pain
Sonographic Murphy sign: Positive
Gangrenous acute cholecystitis
Portal vein thrombosis
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.