IS Case 41: Acute Cholecystitis
Imaging Sciences URMC 2008
Publication Date: 2009-05-19
History
Patient is an 83-year-old woman who presented with right upper quadrant pain after a fall. She had elevated total bilirubin of, alkaline phosphatase, AST, and ALT were all elevated. Amylase and lipase were normal. A gallbladder ultrasound revealed mild thickening of the gallbladder wall, with pericholecystic fluid, and a common bile duct of 1cm. She was admitted to the hospital and placed on antibiotics.
Findings
The gallbladder is markedly distended. There are gallstones present within the gallbladder. There is marked gallbladder wall thickening, gallbladder wall edema and gallbladder wall enhancement. There is no stone in the common bile duct.
Diagnosis
Discussion
Though acute cholecystitis is generally diagnosed by ultrasound or a nuclear medicine scan, it can also be seen on MRI. This patient presented with a picture of biliary obstruction and thus, an MRCP was requested. The typical findings of acute cholecystitis on MRI are seen in this patient: gallstones, and gallbladder wall thickening, edema, and enhancement. There was mild intrahepatic ductal dilatation but no gallstones in the common bile duct (not shown).
Surgery revealed distended, inflamed gallbladder, and areas of patchy necrosis on the wall, with the final clinical diagnosis of acute cholecystitis.
References
- Loud PA, Semelka RC, Kettritz U, Brown JJ, Reinhold C. MRI of acute cholecystitis: comparison with the normal gallbladder and other entities. Magn Reson Imaging. 1996;14(4):349-55. [PMID: 8782171]
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