CASE REPORT   

Journal of Radiological Review 2021 December;8(4):321-5

DOI: 10.23736/S2723-9284.21.00138-0

Copyright © 2021 EDIZIONI MINERVA MEDICA

language: English

Hemorrhagic cholecystitis: a diagnostic challenge where the radiologist can make the difference

Giancarlo GISMONDO VELARDI ✉, Angela TETI, Giuseppe E. GRECO, Sandro BALDARI

Unit of Radiology, G. Jazzolino Hospital, ASP Vibo Valentia, Vibo Valentia, Italy

Hemorrhagic cholecystitis is a rare complication of acute cholecystitis causing abdominal pain. Most common clinical presentation is characterized by Murphy’s sign and Quinke triad, with abdominal pain in high quadrants, jaundice and hematemesis. However, diagnosis can be challenging as symptoms are similar to several common diseases. We present a case of gangrenous hemorrhagic cholecystitis of a patient receiving long-term antiplatelet therapy. The patient underwent abdominal ultrasound, contrasted enhanced abdominal computed tomography scan and magnetic resonance cholangiopancreatography. Diagnostic imaging was fundamental to identify this rare, but potentially fatal, condition and to differentiate it from the most frequent acute calculous cholecystitis. Indeed, densitometric values on computed tomography scan and intensitometry on magnetic resonance intensitometry were crucial to characterize different forms of hemoglobin. The patient underwent urgent laparoscopic cholecystectomy with uneventful postoperative course, preventing further complications such as gallbladder perforation.

KEY WORDS: Cholecystitis; Ultrasonography; Hemobilia; Magnetic resonance imaging