ACUTE CHOLECYSTITIS WITH SUB DIAPHRAGMATIC COLLECTION


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 :

grossly distended gallbladder , with sludge and gallstones and fluid around the gall bladder.

grossly distended gallbladder , with sludge and gallstones and fluid around the gall bladder.

CYSTIC DUCT STONES ARE SEEN

CYSTIC DUCT STONES ARE SEEN

AC CH SD COLL _6

SUB DIAPHRAGMATIC COLLECTION , PROBABLY LOCULATED  WAS ALSO SEEN. MINIMAL RIGHT PLEURAL EFFUSION WAS ALSO SEEN.

AC CH SD COLL _7

pancreas, spleen and both kidneys were normal.

AC CH SD COLL _3

AC CH SD COLL _4

AC CH SD COLL _8

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 )

AC CH SD COLL _9

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.

11 thoughts on “ACUTE CHOLECYSTITIS WITH SUB DIAPHRAGMATIC COLLECTION

    • No.Ideally she should have been investigated further to R/O any cervical obstructive pathology. But the patient was not willing for any further investigations Regards Krishnan

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  1. excluding the endometrial collection , what is the prognosis of diabetic 53 years old male patient diagnosed as ACUTE CALCULUS CHOLECYSTITIS with SUB PHRENIC ABSCESS RT ..and what is the best possible treatment ?? please reply

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