The objective of the present study was to determine whether an analysis of two-phase spiral computed tomographic (CT) features provides a sound basis for the differential diagnosis between gallbladder carcinoma and chronic cholecystitis. Eighty-two patients, 35 with gallbladder carcinoma and 47 with chronic cholecystitis, underwent two-phase spiral CT. We reviewed the two-phase spiral CT features of thickness and enhancement pattern of the gallbladder wall seen during the arterial and venous phases. Mean wall thicknesses were 12.6 mm in the gallbladder carcinoma group and 6.9 mm in the chronic cholecystitis group. The common enhancement patterns seen in gallbladder carcinoma were (a) a highly enhanced thick inner wall layer during the arterial phase that showed isoattenuation with the adjacent hepatic parenchyma during the venous phase (16 of 35, 45.7%) and (b) a highly enhanced thick inner wall layer during both phases (eight of 35, 22.9%). The most common enhancement pattern of chronic cholecystitis was isoattenuation of the thin inner wall layer during both phases (42 of 47, 89.4%). In conclusion, awareness of the wall thickening and enhancement patterns in gallbladder carcinoma and chronic cholecystitis on two-phase spiral CT appears to be valuable in differentiating these two different disease entities.
An 82-year-old woman with cholangitis and common bile duct (CBD) stones underwent endoscopic retrograde cholangiopancreatography (ERCP). An endoscopic sphincterotomy was carried out using an electrosurgical unit with a standard pull sphincterotome. Multiple stones were removed using an extraction balloon, and subsequently, the patient had no pain or fever and a chest radiograph showed no free air. However, 2 days later the patient complained of abdominal pain. Computed tomography (CT) revealed retroperitoneal air and fluid (• " Fig. 1). Given her age and poor medical condition, the patient was not considered a surgical candidate. ERCP disclosed a perforation in the distal CBD near the ampulla. Multiple plastic stents were inserted (• " Fig. 2) and she was treated with total parenteral nutrition, broad-spectrum antibiotics, and percutaneous catheter drainage from the right pararenal space. The fever subsided and the patient's condition improved, but there was no decrease in the amount of percutaneous catheter drainage (> 150 mL/day). A tubo
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