Interesting Case Group 4 Presenting to Radiology Department: Srinakharinwirot University
Interesting Case
Sep 03, 2022
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Case studySrinakharinwirot University
Patient History:
HN: 15964-56
Social History:
Career: Freelance
Substances: No alcohol use/ No smoking
Chief complaint:
Present illness:
relationship to posture
Dysphagia, nausea-vomiting
Present illness:
More severity leads to hospital admission
Physical examination:
Vital sign:
BP 140/80 mmHg, O2 Sat 99%
General appearance:
no jaundice
Physical examination:
CVS : WNL
RS : WNL
Physical examination:
tender at epigastrium and RUQ,
Soft, no rebound tenderness, no guarding,
Normoactive bowel sound
no pitting edema
person, motor grade V all
Murphy’s sign positive
Murphy’s sign positive
common biliary tract disease which shows
fever with right upper quadrant abdominal
pain, no jaundice and Murphy’s sign positive
Lab investigation:
UA:
Laboratory Evaluation
Lab investigation:
Amylase 79 Lipase 138
Suspected gallstone
Laboratory Evaluation
Lab investigation:
Radiology Evaluation
Lab investigation:
Radiology Evaluation
Approach film:
Approach film:
Approach film:
Normal CBD
Approach film:
Normal CBD
epigastrium pain and Murphy’s sign positive.
US:
Conclusion:
CBD
Treatment:
Antibiotics
• Piperacillin-tazobactam
gallbladder neck or cystic duct
More common in female 90%
Acute pain in right upper quadrant
Acute cholecystitis
US finding
Major criteria
Minor criteria
Acute cholecystitis
US finding
Major criteria
obstruction
Often asymptomatic
biliary colic
Choledocholithiasis (CBD stone)
> Central rounded density: stone
> Surrounding lower density: bile
Infective cholangitis : Most common
abdominal pain
biliary obstruction ascending from the
duodenum
Enterobacter 5-10%
Ascending cholangitis
Acute cholangitis
Laboratory test
neutrophil
Acute cholangitis Ascending cholangitis
Acute cholangitis Ascending cholangitis
in men 70%
Primary sclerosing cholangitis
diarrhea
Fever
Primary sclerosing cholangitis
Primary sclerosing cholangitis
epigastrium pain and radiates through to the
back
Acute pancreatitis
Acute pancreatitis
Peripancreatic fluid
in Plain Film Abdomen?
US
1. Gallbladder wall thickening (>3mm)
2. Gallstone
Take Home Message:
• Cholesterol stone
Patient History:
HN: 15964-56
Social History:
Career: Freelance
Substances: No alcohol use/ No smoking
Chief complaint:
Present illness:
relationship to posture
Dysphagia, nausea-vomiting
Present illness:
More severity leads to hospital admission
Physical examination:
Vital sign:
BP 140/80 mmHg, O2 Sat 99%
General appearance:
no jaundice
Physical examination:
CVS : WNL
RS : WNL
Physical examination:
tender at epigastrium and RUQ,
Soft, no rebound tenderness, no guarding,
Normoactive bowel sound
no pitting edema
person, motor grade V all
Murphy’s sign positive
Murphy’s sign positive
common biliary tract disease which shows
fever with right upper quadrant abdominal
pain, no jaundice and Murphy’s sign positive
Lab investigation:
UA:
Laboratory Evaluation
Lab investigation:
Amylase 79 Lipase 138
Suspected gallstone
Laboratory Evaluation
Lab investigation:
Radiology Evaluation
Lab investigation:
Radiology Evaluation
Approach film:
Approach film:
Approach film:
Normal CBD
Approach film:
Normal CBD
epigastrium pain and Murphy’s sign positive.
US:
Conclusion:
CBD
Treatment:
Antibiotics
• Piperacillin-tazobactam
gallbladder neck or cystic duct
More common in female 90%
Acute pain in right upper quadrant
Acute cholecystitis
US finding
Major criteria
Minor criteria
Acute cholecystitis
US finding
Major criteria
obstruction
Often asymptomatic
biliary colic
Choledocholithiasis (CBD stone)
> Central rounded density: stone
> Surrounding lower density: bile
Infective cholangitis : Most common
abdominal pain
biliary obstruction ascending from the
duodenum
Enterobacter 5-10%
Ascending cholangitis
Acute cholangitis
Laboratory test
neutrophil
Acute cholangitis Ascending cholangitis
Acute cholangitis Ascending cholangitis
in men 70%
Primary sclerosing cholangitis
diarrhea
Fever
Primary sclerosing cholangitis
Primary sclerosing cholangitis
epigastrium pain and radiates through to the
back
Acute pancreatitis
Acute pancreatitis
Peripancreatic fluid
in Plain Film Abdomen?
US
1. Gallbladder wall thickening (>3mm)
2. Gallstone
Take Home Message:
• Cholesterol stone
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