JAXEMUS Point-of-Care Ultrasound (POCUS) case series blog.
A middle aged male presents with RUQ abdominal pain and hypotension. During evaluation, a point-of-care ultrasound was performed and is reproduced below.
Hypoechoic fluid was noted on one aspect of the gall bladder. Initially interpreted as acalculous cholecystitis, the patient was begun on treatment for sepsis, including antibiotics and fluids.
However, on the patient’s follow-up CT to confirm the diagnosis, the gall bladder was noted to be normal, and free fluid was noted in the abdomen. The fluid noted on the initial POCUS was later identified as hemoperitoneum from occult trauma.
When the diagnosis is in doubt, additional views, for example a FAST exam, may add further information. In this instance, the lack of significant gall bladder wall thickening and fluid on the liver-adjacent side of the gall bladder lower the suspicion of acalculous cholecystitis. Acalculous cholecystitis is itself a relatively rare diagnosis, accounting for 5-10% of acute cholecystitis. It is found more commonly in immunocompromised patients, the elderly, ICU patients, and those receiving TPN.