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Okay, our next case is a case of right upper quadrant

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pain where the patient actually received a

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CT scan in today's hurried emergency room.

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Frequently, patients are being triaged a CT

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scan with pretty much minimal physical exam.

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So we do get a lot of CT scans of

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patients with right upper quadrant pain.

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Maybe their pain wasn't as defined as necessary

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to get the right upper quadrant ultrasound.

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So I wanted to go through this study.

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Here's a contrast enhanced CT scan.

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You can see that the aorta is brighter than the muscle.

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Indeed, contrast in a portal venous phase where that

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liver is homogeneous and very similar in attenuation

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to the spleen at about 70 seconds after injection.

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As we're coming down, we're going to see

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that the right upper quadrant, the location

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of the gallbladder, there's a very thickened

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gallbladder here, distended with thickened

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wall, and a lot of pericolic disc stranding.

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Um, the fat here is very gray comparatively to the

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normal fat on the other side, and that's just fluid.

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All interdigitated.

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Within those, um, tissue planes

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of the fat as we come down.

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We'll also see the colon.

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It's a little dilated and fluid

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filled and down into the cul-de-sac.

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There is indeed free fluid in this patient as well.

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But let's go on the coronal views.

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I usually call these millennial views, but you know,

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honestly, even I have determined that I love coronals

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almost more than any other plane of imaging on CT scan.

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You can just see all of the structures here, that

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gallbladder is distended, the wall is thickened,

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especially around the level of the liver.

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You come in and demonstrate all of that

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stranding and the like, the colon fluid

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filled, maybe a little bit of ileus there

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because of the bad neighborhood it's living in.

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So this would be a classic appearance

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of cholecystitis on CT scan.

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More and more we're seeing cholecystitis on

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CT scan, so I think that our clinicians need

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to believe us when we call cholecystitis on CT

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scans, and we have to be ready for that as well.