PMC8008203_01
US of the gallbladder presenting hypervascularization of the wall (A), with a gallstone located in the neck (B) and perforation (red arrow) (C). The largest collection of fluid in the subphrenica location (red empty arrow) (D)
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fig1
The gallbladder wall was markedly thickened (up to 13 mm) and hypervascular (Fig. 1A), contracted in the neck and part of the body on a 33 mm stone (Fig. 1B). The further part of the wall of gallbladder body was discontinuous - sonographic signs of perforation (Fig. 1C). The largest fluid collection, measuring about 17 x 56 mm, was seen subphrenically (Fig. 1D), with sonographic appearance of a developing abscess.
US of dilated CHD up to 7.4 mm due to compression of CBD
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fig2
The dilation of intrahepatic bile ducts of both liver lobes and of CHD (common hepatic duct) (up to 7.4 mm - Fig. 2) was noted, proximally to the site of CBD compression.
CT in coronal view, portal phase presenting poorly calcified concrement in the gallbladder neck measuring 18 x 30 mm (A), contracted gallbladder wall with strictures (purple arrows) (B) and location of covered perforation (green arrow) (C). Dilated CHD measuring 7.5 mm (D)
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fig3
Computed tomography of the abdomen with intravenous administration of contrast agent revealed a concrement measuring about 19 x 30 mm in the gallbladder neck (Fig. 3A). The gallbladder wall was partially contracted on the stone and thickened (up to 18 mm in the fundus) (Fig. 3B); stranding in the surrounding fat was noted. A suspicion of covered perforation of the gallbladder accompanied by fluid collection or abscess was raised, even though the fat tissue around the gallbladder fundus was without other abnormalities or signs of free gas (Fig. 3C). CHD was dilated up to 7.2 mm (Fig. 3D).