Reason: look for retained stone in CBD History: abd pain with WBC 27 Please note that there is insufficient contrast in post contrast images.ABDOMEN:LIVER, BILIARY TRACT: There is a perihepatic T2 hyperintense fluid collection measuring 5.6 x 3.0 cm in transverse dimension and 7.6 cm in craniocaudal dimension (501/22, 4 1/28). A fluid fluid level is seen, which may indicate some debris. There is diffusion restriction, suggesting infection. A small tract of fluid is seen extending from the collection along the anterior abdominal wall, adjacent to the cholecystostomy catheter.The cholecystostomy catheter is seen entering the gallbladder, however no significant portion of the drain is seen within the gallbladder lumen. There is cholelithiasis, including stones within the gallbladder neck. There are pericholecystic plantar changes, consistent with history of cholecystitis.Common bile duct measures 6 mm in diameter. There is mild intrahepatic biliary ductal dilatation. No choledocholithiasis.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Subcentimeter T2 hyperintense foci, likely cysts.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Small right pleural effusion and right basilar subsegmental atelectasis. Trace left pleural effusion with linear left basilar atelectasis.
1.Perihepatic fluid collection with a tract extending adjacent to the cholecystostomy catheter is suspected to represent a biloma. Diffusion restriction within the collection suggests infection. 2.The catheter itself enters the gallbladder, however no significant amount of catheter is seen within the gallbladder lumen. It is suspected that the catheter may be retracted and leaking from a sidehole.3.Cholelithiasis and cholecystitis again seen. No choledocholithiasis is identified.Findings discussed with service and interventional radiology team at 8:15 AM on 5/12/2016