PMC9674509_01
Contrast enhanced computed tomography images of the chest. (A and B) Axial and coronal projection images in lung windows demonstrating bilateral mosaic attenuation with peripheral predominant ground-glass opacities in the background of upper lobe predominant centrilobular and paraseptal emphysema. (C and D) Axial images in pulmonary angiogram windows demonstrating hypoattenuating filling defects in the subsegmental pulmonary arteries of the left upper lobe (arrows).
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The patient was admitted to the intensive care unit (ICU) for management of hypoxic respiratory failure secondary to COVID-19 pneumonia (Figs. 1A and B) and initially treated with high flow nasal canula before requiring intubation on hospital day 6. CT of the chest, abdomen, and pelvis subsequently redemonstrated a distended gallbladder as well as hyperattenuating layering material with active contrast extravasation on portal venous images (Fig. 3). Coincident, on the patient's chest images were new left upper lobe subsegmental pulmonary emboli (Figs. 1C and D).
Right upper quadrant ultrasound. (A) Grayscale image demonstrating a distended gallbladder with layering echogenic intraluminal material (arrow). (B) Color Doppler image without evidence of abnormal flow within the gallbladder lumen.
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A right upper quadrant ultrasound revealed new gallbladder distention with layering luminal debris (Fig. 2).
Contrast enhanced axial projection computed tomography images of the upper abdomen. (A) Distended gallbladder with layering hyperattenuating luminal debris (white arrow). (B) Portal venous image demonstrating contrast material extravasation (black arrow) into the gallbladder lumen. (C) Inflammatory fat stranding near the gallbladder fundus (dashed white arrow). (D) Appearance of the gallbladder (GB) 1 year prior.
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CT of the chest, abdomen, and pelvis subsequently redemonstrated a distended gallbladder as well as hyperattenuating layering material with active contrast extravasation on portal venous images (Fig. 3). Coincident, on the patient's chest images were new left upper lobe subsegmental pulmonary emboli (Figs. 1C and D).