Presentation
Chronic recurrent right upper quadrant pain abdomen in a veteran.
Patient Data
Metabolically active gallbladder with gallstone and recommend ultrasound/hepatobiliary scan to evaluate for acute on chronic calculous cholecystitis.
The gallstone has moved from the neck to the fundus of the gallbladder. The mass does not move and so a metabolically active focal gallbladder lesion likely that is inflammatory in nature.
10 months prior to PET C, the large gallstone was in the neck of the gallbladder.
There is a large gallstone, thickened and ill-defined gallbladder wall. This study is 3 weeks after the PET CT. There is a small pericholecystic fluid collection adjacent to the gallbladder and liver.
MRCP showing large stone in the neck of the gall bladder. There is a fluid collection adjacent to the gallbladder - likely a tiny rupture with pericholecystic fluid collection and abscess. No choledocholithiasis.
Case Discussion
The patient underwent laparoscopic surgical cholecystectomy confirming a pericholecystic abscess, extensive adhesions, chronic cholecystitis with mucosal erosions. JP drain was left in place. He was discharged home on antibiotics postoperatively. Do not take comfort that a large gallstone will not cause trouble.