75-year-old female with history of cholelithiasis and cervical cancer. Evaluate for obstructive jaundice and abdominal pain, especially in the right upper quadrant. ABDOMEN:LUNG BASES: Bibasilar atelectasis. Borderline cardiomegaly. Coronary artery calcification.LIVER, BILIARY TRACT: The liver is enlarged and measures 18.3 cm craniocaudally. Hydropic gallbladder is probably filled with sludge. The gallbladder measures more than 12 cm in length and the wall is mildly thickened and edematous. The common bile duct diameter is only 6 mm. No intrahepatic biliary duct dilatation. There are large periportal, hepatic hilar and celiac lymph nodes which have increased in size since the 2007 examination. Findings may be due to acute on chronic cholecystitis. Dedicated multiphase liver CT or MRI exam may be helpful in delineating a subtle neoplastic lesion, although this etiology is less likely. SPLEEN: The spleen is enlarged and measures 14.4 cm. Subcentimeter splenic hypodensities are stable. PANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:UTERUS, ADNEXA: Uterus and adnexa are present. There are calcific densities in the vicinity of the cervix due to prior therapy. No associated lymphadenopathy.BLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted
Interval development of hydropic gallbladder containing sludge with enlargement of celiac, portal and hepatic hilar lymph nodes. Common bile duct and intrahepatic ducts are not dilated. Findings may be due to acute on chronic cholecystitis, but a small neoplasm cannot be excluded. 