50 years, Female, Reason: elevated bili and transaminases, wedge-shaped liver hypodensity on CT. Evaluate gallbladder, biliary tree, hepatic vasculature History: see above. ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT:There are large gallstones with submucosal edema of the gallbladder wall. The adjacent hepatic parenchyma has increased T2 signal with small rim enhancing areas. The gallbladder wall remains distinct without evidence of definite invasion.There is geographic loss of signal in the left hepatic lobe on opposed phase imaging which suggests hepatic steatosis.Mild intrahepatic biliary ductal dilatation with narrowing of the proximal common bile duct, possibly from mass effect from adjacent large cholelithiasis in the gallbladder. The portal vein is mildly narrowed but remains patent.SPLEEN: Small cyst without enhancementPANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Severe right hydronephrosis with large obstructing stones within the right renal pelvis and cortical scarring and thinning.RETROPERITONEUM, LYMPH NODES: Multiple enlarged periportal nodes including a node measuring 2.0 x 2.5 cm (501/26). Additional enlarged gastrohepatic, paraaortic and portacaval nodes.BONES, SOFT TISSUES: No significant abnormality noted.
1. Submucosal gallbladder wall edema and large gallstones with rim enhancing foci and edema in the adjacent hepatic parenchyma. Enlarged localized primarily periportal and portocaval adenopathy. Acute cholecystitis with early intrahepatic abscess formation versus metastatic gallbladder adenocarcinoma (particularly given the adjacent enlarged heterogeneous and perhaps necrotic lymph nodes) are differential considerations. Correlation with patient's clinical history and laboratory values recommended. Definitive diagnosis complicated by patient's reportedly asymptomatic status (making complicated cholecystitis less likely though an element of chronicity is possible) and apparent preservation of gallbladder wall near hepatic parenchymal heterogeneity (making invasive gallbladder malignancy less likely). 2. Mild intrahepatic biliary ductal dilatation.3. Extensive retroperitoneal lymphadenopathy.4. Large obstructing stones in the right renal pelvis with severe hydronephrosis and scarring/thinning, likely acute on chronic findings.