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Case report: an unrecognized etiology of transient gallbladder pain in heart failure diagnosed with internist-performed point-of-care ultrasound.

Desautels CN, Tierney DM, Rossi F, Rosborough TK - Crit Ultrasound J (2015)

Bottom Line: The hour-to-hour timing of this test in a patient with fluctuating symptoms is not widely recognized as having a significant impact on its sensitivity.This case also demonstrates an important etiology of RUQ pain in patients with CHF beyond that of congestive hepatopathy.A review of the related entities of acalculous cholecystitis, congestive hepatopathy, and diffuse gallbladder wall thickening is provided.

View Article: PubMed Central - PubMed

Affiliation: Department of Medical Education, Abbott Northwestern Hospital, Graduate Medical Education, Mail Route #11135, 800 E. 28th Street, Minneapolis, MN 55407 USA.

ABSTRACT
The excellent sensitivity and specificity of right upper quadrant (RUQ) ultrasound for gallbladder pathology in patients with abdominal pain is heavily relied upon in routine diagnostic evaluation. The hour-to-hour timing of this test in a patient with fluctuating symptoms is not widely recognized as having a significant impact on its sensitivity. However, we present a case report describing the essential role of symptom-timed point-of-care ultrasound in making an elusive diagnosis of transient cholecystalgia in a patient with RUQ pain and congestive heart failure (CHF). This case also demonstrates an important etiology of RUQ pain in patients with CHF beyond that of congestive hepatopathy. A review of the related entities of acalculous cholecystitis, congestive hepatopathy, and diffuse gallbladder wall thickening is provided.

No MeSH data available.


Related in: MedlinePlus

Formal right upper quadrant ultrasound #2. (A) Formal ultrasound long axis and (B) short axis views confirming gallbladder wall thickening (0.58 cm, 6 h after bedside ultrasound and initiation of diuresis).
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Fig4: Formal right upper quadrant ultrasound #2. (A) Formal ultrasound long axis and (B) short axis views confirming gallbladder wall thickening (0.58 cm, 6 h after bedside ultrasound and initiation of diuresis).

Mentions: Metronidazole was resumed, and general surgery and gastroenterology were consulted to assist in the management of acute cholecystitis. Diuresis was resumed in light of the POCUS findings supporting new pulmonary edema. A repeat formal RUQ ultrasound (6 h later) (Figure 1, Timeline = ‘Formal RUQ US #2’) confirmed new marked echogenic gallbladder wall thickening (decreased to 6 mm with diuresis between POCUS and the formal study), pericholecystic fluid, and a normal common bile duct with no impacting cholelithiasis (Figure 4). The formal RUQ ultrasound impression was ‘acute cholecystitis.’ Cholecystectomy versus percutaneous cholecystostomy was recommended, pending the outcome of cholescintigraphy and the patient's overall medical stability.Figure 4


Case report: an unrecognized etiology of transient gallbladder pain in heart failure diagnosed with internist-performed point-of-care ultrasound.

Desautels CN, Tierney DM, Rossi F, Rosborough TK - Crit Ultrasound J (2015)

Formal right upper quadrant ultrasound #2. (A) Formal ultrasound long axis and (B) short axis views confirming gallbladder wall thickening (0.58 cm, 6 h after bedside ultrasound and initiation of diuresis).
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4384720&req=5

Fig4: Formal right upper quadrant ultrasound #2. (A) Formal ultrasound long axis and (B) short axis views confirming gallbladder wall thickening (0.58 cm, 6 h after bedside ultrasound and initiation of diuresis).
Mentions: Metronidazole was resumed, and general surgery and gastroenterology were consulted to assist in the management of acute cholecystitis. Diuresis was resumed in light of the POCUS findings supporting new pulmonary edema. A repeat formal RUQ ultrasound (6 h later) (Figure 1, Timeline = ‘Formal RUQ US #2’) confirmed new marked echogenic gallbladder wall thickening (decreased to 6 mm with diuresis between POCUS and the formal study), pericholecystic fluid, and a normal common bile duct with no impacting cholelithiasis (Figure 4). The formal RUQ ultrasound impression was ‘acute cholecystitis.’ Cholecystectomy versus percutaneous cholecystostomy was recommended, pending the outcome of cholescintigraphy and the patient's overall medical stability.Figure 4

Bottom Line: The hour-to-hour timing of this test in a patient with fluctuating symptoms is not widely recognized as having a significant impact on its sensitivity.This case also demonstrates an important etiology of RUQ pain in patients with CHF beyond that of congestive hepatopathy.A review of the related entities of acalculous cholecystitis, congestive hepatopathy, and diffuse gallbladder wall thickening is provided.

View Article: PubMed Central - PubMed

Affiliation: Department of Medical Education, Abbott Northwestern Hospital, Graduate Medical Education, Mail Route #11135, 800 E. 28th Street, Minneapolis, MN 55407 USA.

ABSTRACT
The excellent sensitivity and specificity of right upper quadrant (RUQ) ultrasound for gallbladder pathology in patients with abdominal pain is heavily relied upon in routine diagnostic evaluation. The hour-to-hour timing of this test in a patient with fluctuating symptoms is not widely recognized as having a significant impact on its sensitivity. However, we present a case report describing the essential role of symptom-timed point-of-care ultrasound in making an elusive diagnosis of transient cholecystalgia in a patient with RUQ pain and congestive heart failure (CHF). This case also demonstrates an important etiology of RUQ pain in patients with CHF beyond that of congestive hepatopathy. A review of the related entities of acalculous cholecystitis, congestive hepatopathy, and diffuse gallbladder wall thickening is provided.

No MeSH data available.


Related in: MedlinePlus