Hemorrhagic cholecystitis. Sonographic appearance and clinical presentation.

Abstract

In this retrospective study of 19 patients with hemorrhagic cholecystitis, 14 (74%) patients demonstrated one of the following unusual sonographic features: focal gallbladder wall irregularity; intraluminal membranes; coarse, nonshadowing, nonmobile intraluminal echoes. The clinical presentation of these cases (abdominal pain, 100%; leukocytosis, 74%; fever, 63%) is identical to the classic presentation of acute cholecystitis. Overt gastrointestinal bleeding did not occur.

Haemorrhagic cholecystitis in a newly anticoagulated patient

“…Ultrasound may show thrombi as non-shadowing immobile intraluminal lesions, in addition to the usual wall thickening, pericholecystic fluids and sonographic Murphy’s sign associated with cholecystitis. However, as this case illustrates, sonographic diagnosis remains challenging, with one retrospective study of confirmed haemorrhagic cholecystitis showing features suggestive of this diagnosis in only 74% of patients 1. CT imaging may be enlightening, potentially revealing a fluid filled thickened gallbladder with internal active arterial bleeding 2…”

“…Haemorrhagic cholecystitis is rare, with the literature limited to small series1 and less than 30 English language case reports. It may be due to haemorrhage into an acalculous gallbladder as the primary cause of cholecystitis via chemical irritation.…”

Evaluating Patients with Right Upper Quadrant Pain

“…Clotted blood may appear as a clump or mass adherent to the gallbladder wall or heterogeneous echogenic material, simulating a mass if organized. [162][163][164] In addition to other findings of cholecystitis, CT also shows increased density of bile 157 (see Fig. 31B).…”

Haemorrhagic cholecystitis: a rare entity not to be forgotten

“…It is a rare disease with an estimated incidence of 7% 3. Most of the literature have been limited to case reports or small case series.…”