Comments on: Radiology Oddity #016

By: cnf

cnf — Mon, 25 Apr 2011 13:08:58 +0000

Acalculous cholecystitis in a porcelain gall bladder. She has a high risk of cholangiocarcinoma. A surgeon is required and open cholecystectomy…. It may still be contained.

By: sandnsurf

sandnsurf — Wed, 04 Nov 2009 00:15:05 +0000

Vijay -- so glad to see you rise to the challenge set by the ‘absent’ minded ED physician.
No ducking, no cowering, no brickbats (this time)
- the fairness of a joust can only be determined by reciprocity

Hildy -- Other labs surprising normal with normal LFT and bilirubin levels.
Abdominal examination revealed generalised guarding only.
Thanks for another comprehensive answer comment

By: sandnsurf

sandnsurf — Wed, 04 Nov 2009 00:15:00 +0000

Hildy -- Other labs surprising normal with normal LFT and bilirubin levels.
Abdominal examination revealed generalised guarding only.
Thanks for another comprehensive answer comment

By: Hildy

Hildy — Tue, 03 Nov 2009 19:18:00 +0000

What you can see:

A suprarenal aorta of normal diameter with some calcification --> not a AAA despite the name.
An IVC which is being compressed by something (presumably the gallbladder) but which may be a reflection of inadequate intravascular volume (it doesn’t really look big enough)

This thing in the RUQ:
- fluid density ~3.5-4cm (less dense than the spinous muscles, more dense than fat)
- thin ring of ? enhancing soft tissue density
- eccentric 0.5-1cm rim of fluid density around the soft tissue density ring.

I’m thinking that this represents some pericholecystic free fluid. There seems to be a thin layer of free fluid between the liver and the diaphragm too (presuming the enhancing bit is liver and the nonenhancing STD is diaphragm).

Is that thin ring of STD the gall bladder wall? It’s hard to tell how thick it is.

What’s the lady’s abdo exam like? Other labs?

By: Vijay

Vijay — Tue, 03 Nov 2009 17:15:01 +0000

Disclaimer: It’s not fair to ask a radiologist to comment on a single CT section, chosen by an absent-minded Emergency Physician.

Still, I will answer because the gauntlet has been thrown (tweeted) in my face.

Based on this single CT axial section (part of what is no doubt hundreds of such axial sections from a multislice CECT Abdomen) i opine that this old lady has Acalculous Cholecystitis.

(Ducking & cowering. Waiting for the brickbats.)