CASE 23: 55 y/o female with RUC pain

Patient came to the ED with history of acute abdominal pain, suspected (+) Murphy's sign and mild jaundice. She had previous ultrasound showing gallstones several months ago. Calculous Cholecystitis was suspected so an ultrasound was conduced.

Bloodwork showed an obstructive pattern on billirubin serum levels but also high in Lactate Dehydrogenase and  mild elevation of Alanine Transaminase and Aspartate Transaminase levels. This was a concern to me on hepatic parenquimal integrity.

Here are the US gallbladder (VB) images: (soory the poor quality but click to enlarge)

The suitable exam to better characterize findings is a CT:

I wanted to see first a non contrast phase due to some suspected areas shown in ultrasound that produced posterior acoustic shadowing.

I wanted also a late phase (120 segs) to see the demeanor of the lesion.

Findings?..Differentials?..


Soon the conclusion..