0:00

Alright, our next case is a contrast-enhanced

0:03

CT scan again, but oh my gosh, this patient

0:05

is prone, this is being done as a CT urogram,

0:09

so this is already all forms of cockamamie

0:11

that the patient is coming in for a urogram.

0:13

I'm going to flip this patient over because I

0:15

have that right and start from our convention.

0:18

Obviously, the symptoms were really hard to validate on

0:21

physical exam if a patient started with a urogram here.

0:24

So, we again have the right upper quadrant with

0:26

our liver, but as we come down, this gallbladder

0:30

is, again, very thickened wall as well, with a lot

0:33

of pericystic stranding, and you can actually

0:36

lose the gallbladder wall in multiple locations.

0:39

So, this gallbladder is not only a thickened and

0:42

acute cholecystitis, but the fact that the patient

0:45

has absolute gallbladder wall dehiscence and has

0:48

such a poor correlation with physical exam that

0:51

they got a urogram would indicate that maybe

0:53

this is even worse than normal cholecystitis.

0:55

They aren't presenting with your normal

0:57

right upper quadrant pain because this

0:59

indeed is gangrenous cholecystitis.

1:02

In that case, the patient's neuroenteric

1:04

plexus no longer innervates the gallbladder,

1:06

and the patient may not have very specific

1:09

symptomatology.

1:11

Um, this is a beautiful example with that

1:14

incomplete enhancement and a lot of pericystic

1:17

fluid, some thickening at the gallbladder base.

Case: Gangrenous Cholecystitis

HIDE

Prev Next

Interactive Transcript

Pro Tip: Click on a word in the transcript to jump to that point in the video