Acute complicated calculous cholecystitis

Case contributed by Dr Varun Babu

Presentation

Febrile illness followed by right upper abdominal pain.

Patient Data

Age: 40 years
Gender: Male

Features of active gall bladder inflammation in the form of circumferential mural thickening, mural hyperenhancement, mild pericholecystic free fluid and dependent multiple <3 mm calculi. 

Filling defect seen in anterior branch of right portal vein. Secondary differential hepatic attenuation of segment V and VIII. Rest of the portal system, the hepatic arterial and venous systems are patent. 

Annotated image

Annotated images depicting the above findings.

Image 1: Pericholecystic free fluid
Image 2: Differential hepatic attenuation
Image 3: Anterior segment right portal vein bland thrombus
Image 4: Radiodense gall stone

Case Discussion

This is an uncommon case of acute calcular cholecystitis getting complicated by segmental portal venous thrombosis. Cholecystitis being a hypercoagulable state, disseminated intravascular coagulation may occur and should be looked out for. 

The differential segmental hepatic attenuation is due to the post thrombotic increased hepatic arterial flow to segments V and VIII. 

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Case information

rID: 55202
Published: 25th Aug 2017
Last edited: 2nd Sep 2019
Inclusion in quiz mode: Included
Institution: Vivid Diagnostic Centre

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