This was a 90 year old lady who presented with history of Right upper quadrant pain and fever with chills for the last 1 month. She was given PPI’s and antibiotics and was not improving. She came with a rider that she was not willing for any surgical treatment.
Her ultrasound showed the following findings :
pancreas, spleen and both kidneys were normal.
The pelvic scan had a surprise finding. Prominent fluid collection was seen in the endometrial cavity with echogenic cervix. ( She had no symptom of any vaginal bleeding or discharge )
The diagnosis was : acute calculous cholecystitis , cystic duct stones causing a rupture and fluid collection around the GB and loculated sub diaphragmatic collection with reactive mild right pleural effusion . Endometrial fluid collection needed further evaluation.
The patient was referred to a surgeon , who advised her surgery. The patient declined surgery and was lost for further follow up.