Hospital: Hospital Universitari de Bellvitge.
Ciudad:
Nº:
Aut@r o Autores: M. Pérez Rubiralta, A. Dorca Duch, D. Pittí Freiburghaus, M.M. Serra Salas, D.E. Nova Vaca, J. García Bennet.,
Presentación:
63 year old male with diabetes mellitus and periferal vasculopathy who came to the emergency department referring asthenia, vague lumbar pain, choluria and acholia of recent appearance, showing signs of sepsis (fever and hypotension).
Discusión:
An abdominal ultrasound was performed, disclosing a hydropic gallbladder with thickened walls and bubbles inside, and abundant aerobilia in the left hepatic lobe, suspicious of emphysematous cholecystitis. The abdominal MDCT showed mural thickening and hypoenhancement of the gallbladder wall. No mural emphysema was visible, but abundant intraluminal gas, creating a fluid-air interface with a wavy appearance (pomegranate sign). A lithiasis was visible in the infundibulum. Aerobilia in the left biliary tree and in the cystic duct was also visible. A repletion defect of the left portal branch was identified, indicating secondary thrombophlebitis. Additionaly, signs suggestive of shock with periportal edema, hypoperfusion of the liver (right lobe) and spleen, adrenal hyperfunctionalism and renal function delay existed. The findings were suggestive of emphysematous cholecystitis with secondary portal thrombophlebitis (pylephlebitis) and associated signs of septic shock.
Conclusión:
An abdominal ultrasound was performed, disclosing a hydropic gallbladder with thickened walls and bubbles inside, and abundant aerobilia in the left hepatic lobe, suspicious of emphysematous cholecystitis. The abdominal MDCT showed mural thickening and hypoenhancement of the gallbladder wall. No mural emphysema was visible, but abundant intraluminal gas, creating a fluid-air interface with a wavy appearance (pomegranate sign). A lithiasis was visible in the infundibulum. Aerobilia in the left biliary tree and in the cystic duct was also visible. A repletion defect of the left portal branch was identified, indicating secondary thrombophlebitis. Additionaly, signs suggestive of shock with periportal edema, hypoperfusion of the liver (right lobe) and spleen, adrenal hyperfunctionalism and renal function delay existed. The findings were suggestive of emphysematous cholecystitis with secondary portal thrombophlebitis (pylephlebitis) and associated signs of septic shock.
Bibliografía:
Schiappacasse G, Soffia P, Silva C, Villacrés F, et al. Computed tomography imaging of complications of acute cholecystitis. Indian J Radiol Imaging. 2018 Apr-Jun, 28(2): 195–199