Presentation
Acute onset of right upper quadrant pain with two days of vomiting.
Patient Data
Age: 35 years
Gender: Male
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Marked dilatation of the extra-hepatic billary tree. There is also a large stone located in the Hartman's pouch, with compression of the adjacent CBD.
Biliary sludge with thickened gallbladder wall.
No intrahepatic duct dilatation.
Case Discussion
The presence of a large stone in the cystic duct or Hartman's pouch, with gallbladder wall thickening and retained biliary sludge and the clinical picture, are highly suggestive of acute calcular cholecystitis.
The presence of isolated dilatation of the proximal extrahepatic CBD, is suggestive for Mirizzi syndrome.
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