0:00

Okay, here we have another, um, abdominal CT

0:03

scan done with portal venous phase of imaging.

0:07

As we come down, you can see that again,

0:08

the, the liver here is a bit lower in

0:11

attenuation consistent with fatty infiltration.

0:13

Again, that little area of, um,

0:15

increased fatty infiltration along the

0:17

falciform ligament, kind of a classic.

0:20

And as we come down, we can see that the gallbladder

0:22

is distended and that there's increased attenuation,

0:26

um, or enhancement around the gallbladder

0:28

fossa, somewhat like a halo of enhancement.

0:30

That's a frequent finding of cholecystitis on CT scan.

0:34

This case doesn't have significant thickening, but

0:36

there is a bit of pericholecystic fluid as well.

0:39

Now as we come up into the

0:40

gallbladder neck, we can just

0:42

barely perceive that there is

0:45

a calcified gallstone there.

0:46

That one's gonna try to hide from you, but

0:47

don't worry, you're good at what you do,

0:49

so you're gonna make that diagnosis.

0:51

So you actually have an obstructing gallstone,

0:53

well seen on the CT scan, if looked for.

0:56

And as we come down, you'll see that this

0:58

gallbladder actually is pushing against the

1:01

abdominal wall, pushing that muscle over.

1:03

This is called the tensile gallbladder

1:05

sign, and it's just an indication that there's enough

1:08

force in your gallbladder to push your muscle.

1:11

That's saying quite a bit, right?

1:13

Because the gallbladder I told you

1:14

is it's pretty weak, it's floppy.

1:16

So for it to get angry enough to push

1:18

away its, uh, muscle, means that it is

1:20

pretty inflamed and obstructed as well.

1:23

As we come down, you can see that the GI

1:25

tract is not obstructed and everything looks

1:28

pretty good on that mark.

1:30

So this patient on coronals will come through,

1:32

again seeing that calcified gallstone right

1:35

there in the, um, neck of the gallbladder.

1:38

That gallbladder distended with the halo sign

1:41

of enhancement of the adjacent liver parenchyma.

1:44

A tiny bit of pericholecystic fluid is present,

1:47

and that tensile gallbladder sign as well.

1:50

So this is another sign of

1:52

acute cholecystitis on CT scan.