Fever and right hypochondrium pain: beyond acute cholecysitis. A diagnostic challenge in US practice.

Congress:

ECR 2020

Poster Number:

C-09352

Type:

Educational Exhibit

Keywords:

Performed at one institution, Not applicable, Inflammation, Infection, Abscess, Diagnostic procedure, Ultrasound-Power Doppler, Ultrasound-Colour Doppler, Ultrasound, Liver, Emergency, Abdomen, Abdominal Viscera

Authors:

A. A. Ramos Muñoz, I. Tamayo-González, J. L.ABRALDES, A. Perez Lara, M. M. MOLINERO-CASARES, J. Vicente-Romo; Málaga/ES

DOI:

10.26044/ecr2020/C-09352

DOI-Link:

https://dx.doi.org/10.26044/ecr2020/C-09352

Fig. 1: US images unequivocal for acute cholecystitis in three different patients...

Fig. 3: Algorithm proposed to perform proper imaging exams for achieving an accurate...

Fig. 4: Diagram representing the results obtained in our retrospective analysis. AC was...

Fig. 8: 19 year-old woman presenting with fever and abdominal pain for 8 days....

Fig. 14: 83 year-old women admitted with fever and right upper quadrant pain. She had...

Learning objectives

This review aims to describe the differential diagnosis that has to be considered in patients suffering from fever and right hypochondrium pain when the first diagnosis of suspicion -acute cholecystitis- has been ruled out.

Background

The clinical status of the patient and certain abnormalities in blood test results such as leukocytosis and acute phase proteins increase can guide to AC diagnosis; however, these findings are nonspecific and oftenly are not present. Ultrasound imaging (US) is the fist-line imaging modality to be performed due to its advantages such as its low cost and high disponibility allowing to be performed even at the patient’s bedside. In addition, this imaging technique does not use ionizing radiation so it can be repetead if necessary...

Findings and procedure details

To illustrate the wide range of diagnostic possibilities in patients with fever and right hypochondrium pain, a retrospective analysis of 123 cases of patients with these symptoms admitted in our institution from May to October 2019 was performed. They were firstly evaluated by an urgent abdominal US examination and several different diagnoses were made (Fig. 4). Acute cholangitis An US examination is mandatory to evaluate the bile ducts if this entity is suspected. The main radiological findings are intrahepatic and/or extrahepatic bile duct dilatation (over...

Conclusion

Despite the knowledge of AC ultrasound signs, the fact that several entities may simulate the same clinical scenario supposes a diagnostic challenge in patients suffering from fever and right hypochondrium pain. Owing to its advantages and versatility, abdominal sonography performed in B-mode, Doppler color mode and CEUS is an excellent technique to provide a specific diagnosis in these patients without needing to carry out any additional exam in most of cases.

Personal information and conflict of interest

A. A. Ramos Muñoz; Málaga/ES - nothing to disclose J. Vicente-Romo; Málaga/ES - nothing to disclose J. L.Abraldes; Málaga/ES - nothing to disclose M. M. Molinero-Casares; Málaga/ES - nothing to disclose I. Tamayo-González; Málaga/ES - nothing to disclose A. Perez Lara; Malaga/ES - nothing to disclose

References

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