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.

9 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

      Sent from my iPad

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