Abstract
A history of laparoscopic cholecystectomy and mobile echogenic foci identified on abdominal ultrasound may distinguish dropped gallstones complicated by abscess from other conditions that exhibit similar findings.
Keywords: abdominal ultrasound, dropped gallstones, mobile echogenic foci, perihepatic abscess
Well‐circumscribed, subdiaphragmatic thick‐walled lesion with echogenic foci with posterior acoustic shadowing.
1. CASE HISTORY
A 59‐year‐old woman presented with a 1‐week history of intermittent right upper quadrant (RUQ) discomfort. She had undergone laparoscopic cholecystectomy 2 years ago. Her vital signs were unremarkable, and RUQ tenderness was observed. Abdominal computed tomography (CT) with contrast revealed subdiaphragmatic rim‐enhancing fluid collection causing mass effect on the right hepatic lobe, suggestive of an abscess (Figure 1A). RUQ ultrasound (US) findings revealed a thick‐walled lesion with mobile echogenic foci with posterior acoustic shadowing (Figure 1B), which could not be observed on CT, even in retrospect. Laparoscopic aspiration revealed purulent fluid with three lithiases. Abscess culture showed Pseudomonas aeruginosa, and she was treated with ciprofloxacin for 5 days.
FIGURE 1.
(A) Rim‐enhancing right subdiaphragmatic collection (4.3 × 4.1 × 4.1 cm) (red arrow). (B) Well‐circumscribed, thick‐walled lesion with echogenic foci with posterior acoustic shadowing (white arrow)
2. DISCUSSION
Dropped gallstones complicated by abscess may be observed after laparoscopic cholecystectomy. Typically, CT and US findings demonstrate perihepatic fluid with highly attenuated foci. 1 However, minute or non‐calcified stones may be overlooked upon CT. US findings may support the diagnosis by demonstrating mobile stones, such as that noted in this case. 1
Prior laparoscopic cholecystectomy and mobile high‐attenuation foci on abdominal US may help distinguishing dropped gallstones, complicated by abscess from other similar findings. This is important as gallstone‐related abscesses require removal of all stones to prevent recurrent abscesses formation. 2
CONFLICT OF INTEREST
None.
AUTHOR CONTRIBUTIONS
YH and PM collected data and information, and served as main writer of the present work.
CONSENT
Written informed consent was obtained from the patient to publish this report in accordance with the journal's patient consent policy.
ACKNOWLEDGEMENTS
Nothing to disclose.
Hoshina Y, Miro P. Perihepatic fluid collection with mobile echogenic foci. Clin Case Rep. 2022;10:e05291. doi: 10.1002/ccr3.5291
Funding information
Nothing to declare.
DATA AVAILABILITY STATEMENT
Data sharing is not applicable to this article as no datasets were generated or analyzed during the current study.
REFERENCES
- 1. Nayak L, Menias CO, Gayer G. Dropped gallstones: spectrum of imaging findings, complications and diagnostic pitfalls. Br J Radiol. 2013;86(1028):20120588. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 2. Ramamurthy NK, Rudralingam V, Martin DF, Galloway SW, Sukumar SA. Out of sight but kept in mind: complications and imitations of dropped gallstones. Am J Roentgenol. 2013;200(6):1244‐1253. [DOI] [PubMed] [Google Scholar]
Associated Data
This section collects any data citations, data availability statements, or supplementary materials included in this article.
Data Availability Statement
Data sharing is not applicable to this article as no datasets were generated or analyzed during the current study.