A 42-year-old woman presents to the emergency department reporting severe, colicky pain in her right upper abdomen that began shortly after eating a large, fatty meal. The pain radiates to her right scapula. She is febrile to 38.3°C (101°F). Physical examination reveals marked tenderness to palpation in the right upper quadrant, with a sudden halt in inspiration when the area is deeply palpated. A right upper quadrant abdominal ultrasound is obtained, which demonstrates an echogenic focus within the gallbladder with posterior acoustic shadowing, a gallbladder wall thickness of 5.5 mm, and a rim of anechoic fluid surrounding the gallbladder. Based on these imaging findings, which of the following is the most accurate diagnosis?
- Acute cholecystitisCevap
- BUncomplicated cholelithiasis
- CCholedocholithiasis
- DAcute cholangitis
- EAcute acalculous cholecystitis
Cevap
Acute cholecystitis
The correct answer is acute cholecystitis. The patient's clinical presentation (fever, right upper quadrant pain, positive Murphy sign) is highly suggestive of gallbladder inflammation. The ultrasound definitively confirms this diagnosis by demonstrating a gallstone (echogenic focus with posterior acoustic shadowing) accompanied by signs of active local inflammation, specifically a thickened gallbladder wall (5.5 mm, which is abnormally >3 mm) and a rim of anechoic pericholecystic fluid.
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Anahtar Kavram
The sonographic hallmarks of acute cholecystitis include the presence of gallstones (echogenic foci with posterior shadowing), gallbladder wall thickening (greater than 3 mm), and pericholecystic fluid.