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Acute Cholecystitis

Sexton JJS - MedPix (2010)

View Article: MedPix Image - MedPix Case

Affiliation: Uniformed Services University

ABSTRACT

Diagnosis: Acute Cholecystitis

History: A 53 year old man presents with continuous burning pain in the right upper quadrant of the abdomen for 4 hours. He reports nausea, but denies vomiting. His last meal was seven hours ago and consisted of "spicy Mexican" food. Past medical history is significant only for GERD.

Findings: The gallbladder wall measures approximately 4mm. There is no evidence of cholelithiasis or pericholecystic fluid. The gallbladder demonstrates dependent layering sludge. There is a 10x9 mm echogenic focus within the dependent portion of the gallbladder without posterior shadowing and demonstrates internal flow. HIDA scan with morphine challenge failed to visualize the gallbladder.

Ddx: Cholecystitis vs. biliary colic vs. gallbladder pathology NOS.

Dxhow: HIDA Scan

Exam: EXAM: -Afebrile with stable vital signs. -Abdominal exam reveals only tenderness to palpation in the RUQ. LABS: -WBC 10.9 -AST/ALT/AlkP: 32 / 56 / 81 -TBili: 0.3

No MeSH data available.


Images are captured over the course of four hours for greatest accuracy. If the gallbladder is not visualized at one hour after administration of radiotracer, and the small bowel is visualized (suggesting that there is no biliary obstruction), then a morphine challenge may be administered to avoid waiting four hours for study completion. In this patient, the biliary tree was visualized within 8 minutes, and the small bowel was visualized within 14 minutes into the study. However, the gallbladder was not visualized after one hour.
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MPX2036_synpic52420: Images are captured over the course of four hours for greatest accuracy. If the gallbladder is not visualized at one hour after administration of radiotracer, and the small bowel is visualized (suggesting that there is no biliary obstruction), then a morphine challenge may be administered to avoid waiting four hours for study completion. In this patient, the biliary tree was visualized within 8 minutes, and the small bowel was visualized within 14 minutes into the study. However, the gallbladder was not visualized after one hour.


Acute Cholecystitis

Sexton JJS - MedPix (2010)

Images are captured over the course of four hours for greatest accuracy. If the gallbladder is not visualized at one hour after administration of radiotracer, and the small bowel is visualized (suggesting that there is no biliary obstruction), then a morphine challenge may be administered to avoid waiting four hours for study completion. In this patient, the biliary tree was visualized within 8 minutes, and the small bowel was visualized within 14 minutes into the study. However, the gallbladder was not visualized after one hour.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=MPX2036&req=5

MPX2036_synpic52420: Images are captured over the course of four hours for greatest accuracy. If the gallbladder is not visualized at one hour after administration of radiotracer, and the small bowel is visualized (suggesting that there is no biliary obstruction), then a morphine challenge may be administered to avoid waiting four hours for study completion. In this patient, the biliary tree was visualized within 8 minutes, and the small bowel was visualized within 14 minutes into the study. However, the gallbladder was not visualized after one hour.

View Article: MedPix Image - MedPix Case

Affiliation: Uniformed Services University

ABSTRACT

Diagnosis: Acute Cholecystitis

History: A 53 year old man presents with continuous burning pain in the right upper quadrant of the abdomen for 4 hours. He reports nausea, but denies vomiting. His last meal was seven hours ago and consisted of "spicy Mexican" food. Past medical history is significant only for GERD.

Findings: The gallbladder wall measures approximately 4mm. There is no evidence of cholelithiasis or pericholecystic fluid. The gallbladder demonstrates dependent layering sludge. There is a 10x9 mm echogenic focus within the dependent portion of the gallbladder without posterior shadowing and demonstrates internal flow. HIDA scan with morphine challenge failed to visualize the gallbladder.

Ddx: Cholecystitis vs. biliary colic vs. gallbladder pathology NOS.

Dxhow: HIDA Scan

Exam: EXAM: -Afebrile with stable vital signs. -Abdominal exam reveals only tenderness to palpation in the RUQ. LABS: -WBC 10.9 -AST/ALT/AlkP: 32 / 56 / 81 -TBili: 0.3

No MeSH data available.