EURORAD ESR

Case 9505

Contained gallbladder perforation complicating acute cholecystitis

Author(s)
Tonolini Massimo, MD

"Luigi Sacco" University Hospital, Radiology Department;
Via G.B. Grassi 74 20157 Milan, Italy;
Email:mtonolini@sirm.org
 
Patient
male, 49 year(s)
 
 
  • Figure 1
    Contrast-enhanced CT
     

    Unenhanced (a) and portal venous phase enhanced (b,c) images confirm overdistended gallbladder with enhancing mural thickening, marked inflammatory changes of the surrounding fat consistent with acute cholecystitis.

     
    Area of Interest: Biliary Tract / Gallbladder; Imaging Technique: CT; Procedure: Abscess delineation; Special Focus: Acute;

    Unenhanced (a) and portal venous phase enhanced (b,c) images confirm overdistended gallbladder with enhancing mural thickening, marked inflammatory changes of the surrounding fat consistent with acute cholecystitis.

     
    Area of Interest: Biliary Tract / Gallbladder; Imaging Technique: CT; Procedure: Abscess delineation; Special Focus: Acute;

    Unenhanced (a) and portal venous phase enhanced (b,c) images confirm overdistended gallbladder with enhancing mural thickening, marked inflammatory changes of the surrounding fat, plus hypodense collection surrounding...

     
    Area of Interest: Biliary Tract / Gallbladder; Imaging Technique: CT; Procedure: Abscess delineation; Special Focus: Acute;

    Axial unenhanced (d) and portal venous phase enhanced (e) images show a 3 cm non-enhancing hypodense collection abutting the gallbladder fundus, consistent with abscess due to contained perforation.

     
    Area of Interest: Biliary Tract / Gallbladder; Imaging Technique: CT; Procedure: Abscess delineation; Special Focus: Acute;

    Axial unenhanced (d) and portal venous phase enhanced (e) images show a 3 cm non-enhancing hypodense collection abutting the gallbladder fundus, consistent with abscess due to contained perforation.

     
    Area of Interest: Biliary Tract / Gallbladder; Imaging Technique: CT; Procedure: Abscess delineation; Special Focus: Acute;
     
     
  • Figure 2
    Unenhanced MRI
     

    Axial T2- (a) and T1-(b) weighted images show overdistended gallbladder neck abutting the hepatic hilum, with hyperintense oedematous signal in the adjacent liver parenchyma.

     
    Area of Interest: Biliary Tract / Gallbladder; Imaging Technique: MR; Procedure: Cholangiography; Special Focus: Acute;

    Axial T2- (a) and T1-(b) weighted images show overdistended gallbladder neck abutting the hepatic hilum, with hyperintense oedematous signal in the adjacent liver parenchyma.

     
    Area of Interest: Biliary Tract / Gallbladder; Imaging Technique: MR; Procedure: Cholangiography; Special Focus: Acute;

    Axial T1-weighted image confirm overdistended gallbladder with diffuse luminal hyperintensity consistent with biliary sludge and microlithiasis.

     
    Area of Interest: Biliary Tract / Gallbladder; Imaging Technique: MR; Procedure: Cholangiography; Special Focus: Acute;

    Axial T2-weighted image shows distended gallbladder with mural thickening and inflammatory changes of the surrounding fat planes.

     
    Area of Interest: Biliary Tract / Gallbladder; Imaging Technique: MR; Procedure: Cholangiography; Special Focus: Acute;

    Coronal (e) and axial (f,g) T2- plus axial T1-weighted (h) images show overdistended gallbladder with biliary sludge and lithiasis, and a 3 cm collection abutting its fundus.

     
    Area of Interest: Biliary Tract / Gallbladder; Imaging Technique: MR; Procedure: Cholangiography; Special Focus: Acute;

    Coronal (e) and axial (f,g) T2- plus axial T1-weighted (h) images show overdistended gallbladder with biliary sludge and lithiasis, and a 3 cm collection abutting its fundus.

     
    Area of Interest: Biliary Tract / Gallbladder; Imaging Technique: MR; Procedure: Cholangiography; Special Focus: Acute;

    Pericholecystic collection shows stratified signal intensity analogous to that of the gallbladder lumen on both T1- (g) and T2-weighted (h) detailed images.

     
    Area of Interest: Biliary Tract / Gallbladder; Imaging Technique: MR; Procedure: Cholangiography; Special Focus: Acute;

    Pericholecystic collection shows stratified signal intensity analogous to that of the gallbladder lumen on both T1- (g) and T2-weighted (h) detailed images.

     
    Area of Interest: Biliary Tract / Gallbladder; Imaging Technique: MR; Procedure: Abscess delineation; Special Focus: Acute;
     
     
  • Figure 3
    MR Cholangio-Pancreatography (MRCP)
     

    MIP-reformatted (a) and native thin-slab (b) images confirm overdistended gallbladder with sludge and lithiasis, plus fluid-like collection abutting its fundus consistent with contained perforation.

     
    Area of Interest: Biliary Tract / Gallbladder; Imaging Technique: MR; Procedure: Cholangiography; Special Focus: Acute;

    MIP-reformatted (a) and native thin-slab (b) images confirm overdistended gallbladder with sludge and lithiasis, plus fluid-like collection abutting its fundus consistent with contained perforation.

     
    Area of Interest: Biliary Tract / Gallbladder; Imaging Technique: MR; Procedure: Cholangiography; Special Focus: Acute;

    Oblique-coronal thick-slab MRCP image show moderate intrahepatic biliary dilatation due to overdistended gallbladder neck compressing the common bile duct, normal-sized choledochus and main pancreatic ducts.

     
    Area of Interest: Biliary Tract / Gallbladder; Imaging Technique: MR; Procedure: Cholangiography; Special Focus: Acute;
     
     
Unenhanced (a) and portal venous phase enhanced (b,c) images confirm overdistended gallbladder with enhancing mural thickening, marked inflammatory changes of the surrounding fat consistent with acute cholecystitis.
 
Unenhanced (a) and portal venous phase enhanced (b,c) images confirm overdistended gallbladder with enhancing mural thickening, marked inflammatory changes of the surrounding fat consistent with acute cholecystitis.
 
Unenhanced (a) and portal venous phase enhanced (b,c) images confirm overdistended gallbladder with enhancing mural thickening, marked inflammatory changes of the surrounding fat, plus hypodense collection surrounding the fundus.
 
Axial unenhanced (d) and portal venous phase enhanced (e) images show a 3 cm non-enhancing hypodense collection abutting the gallbladder fundus, consistent with abscess due to contained perforation.
 
Axial unenhanced (d) and portal venous phase enhanced (e) images show a 3 cm non-enhancing hypodense collection abutting the gallbladder fundus, consistent with abscess due to contained perforation.
 
Axial T2- (a) and T1-(b) weighted images show overdistended gallbladder neck abutting the hepatic hilum, with hyperintense oedematous signal in the adjacent liver parenchyma.
 
Axial T2- (a) and T1-(b) weighted images show overdistended gallbladder neck abutting the hepatic hilum, with hyperintense oedematous signal in the adjacent liver parenchyma.
 
Axial T1-weighted image confirm overdistended gallbladder with diffuse luminal hyperintensity consistent with biliary sludge and microlithiasis.
 
Axial T2-weighted image shows distended gallbladder with mural thickening and inflammatory changes of the surrounding fat planes.
 
Coronal (e) and axial (f,g) T2- plus axial T1-weighted (h) images show overdistended gallbladder with biliary sludge and lithiasis, and a 3 cm collection abutting its fundus.
 
Coronal (e) and axial (f,g) T2- plus axial T1-weighted (h) images show overdistended gallbladder with biliary sludge and lithiasis, and a 3 cm collection abutting its fundus.
 
Pericholecystic collection shows stratified signal intensity analogous to that of the gallbladder lumen on both T1- (g) and T2-weighted (h) detailed images.
 
Pericholecystic collection shows stratified signal intensity analogous to that of the gallbladder lumen on both T1- (g) and T2-weighted (h) detailed images.
 
MIP-reformatted (a) and native thin-slab (b) images confirm overdistended gallbladder with sludge and lithiasis, plus fluid-like collection abutting its fundus consistent with contained perforation.
 
MIP-reformatted (a) and native thin-slab (b) images confirm overdistended gallbladder with sludge and lithiasis, plus fluid-like collection abutting its fundus consistent with contained perforation.
 
Oblique-coronal thick-slab MRCP image show moderate intrahepatic biliary dilatation due to overdistended gallbladder neck compressing the common bile duct, normal-sized choledochus and main pancreatic ducts.
 
 
 
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