Acalculous cholecystitis.A 55-year old man who developed severe right upper quadrant pain four days after undergoing shoulder surgery. Clinically the patient had acute cholecystitis. An ultrasound showed a normal gallbladder and no stones.
This HIDA scan shows prompt and uniform uptake of tracer by the liver. By 10 minutes activity had entered the small intestine. There was free flow of tracer throughout the small bowel. Between 35 - 40 minutes some entero-gastric reflux was observed. There was no evidence of gallbladder visualisation - even after 2 mg of intravenous morphine and more radio-tracer. This supports the clinical picture of acute acalculous cholecystitis.
Four weeks later the patient underwent a laparoscopic cholecystectomy and a necrotic thick-walled gallbladder was removed. There were no stones.
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