Case Of the Month June 2016
Findings
Ultrasound scan pictures: ? Vascular inflammatory mass with calcifications within GB. Cystic duct contained a few small calculi. CBD measured 7 mm in diameter. Previous Ultrasound scan done elsewhere about 3 months before showed cholangitis, calculus cholecystitis and obstructing CBD calculi. Patient then had ERCP and Sphincterotomy. CT Scan pictures: Findings similar to those described on Ultrasound. Pericholecystic fat stranding is noted raising the possibility of a previous contained leak. No CBD calculus. No biliary duct dilatation.
Discussion
1. What is the echogenic abnormality within the GB? Answer: Gall stones associated with significant cholecystitis
2. Why is it vascular on Doppler? Answer: Severe inflammatory changes can give this appearance.
3. Is the CBD obstructed? Answer: No
4. What is the atypical appearance of the gall bladder due to? Answer: Recurrent attacks of Cholecystitis from the known calculi can give this appearance, especially increased Vascularity along the gall bladder walls. Management: Patient underwent surgery and it was found that he had a chronically inflamed significantly distended gall bladder with presence of several calculi and some concretions and the gall bladder was markedly adherent to the undersurface of the liver. Why is this case being presented here? To highlight the importance of how chronic recurrent calculus cholecystitis can mimick a gall bladder tumour on both Ultrasound and CT. It is important to keep this in mind when issuing reports due to the implications on further investigations and in planning management.
Findings
Ultrasound scan pictures: ? Vascular inflammatory mass with calcifications within GB. Cystic duct contained a few small calculi. CBD measured 7 mm in diameter. Previous Ultrasound scan done elsewhere about 3 months before showed cholangitis, calculus cholecystitis and obstructing CBD calculi. Patient then had ERCP and Sphincterotomy. CT Scan pictures: Findings similar to those described on Ultrasound. Pericholecystic fat stranding is noted raising the possibility of a previous contained leak. No CBD calculus. No biliary duct dilatation.
Discussion
1. What is the echogenic abnormality within the GB? Answer: Gall stones associated with significant cholecystitis
2. Why is it vascular on Doppler? Answer: Severe inflammatory changes can give this appearance.
3. Is the CBD obstructed? Answer: No
4. What is the atypical appearance of the gall bladder due to? Answer: Recurrent attacks of Cholecystitis from the known calculi can give this appearance, especially increased Vascularity along the gall bladder walls. Management: Patient underwent surgery and it was found that he had a chronically inflamed significantly distended gall bladder with presence of several calculi and some concretions and the gall bladder was markedly adherent to the undersurface of the liver. Why is this case being presented here? To highlight the importance of how chronic recurrent calculus cholecystitis can mimick a gall bladder tumour on both Ultrasound and CT. It is important to keep this in mind when issuing reports due to the implications on further investigations and in planning management.