Keywords: abdominal pain; cholecystitis; congestive hepatopathy; pericardial effusion

Citation: Fontes CP, Fontoura MG, Teixeira M. Pseudo cholecystitis as a first impression of pericardial effusion. Open J Clin Med Images. 2021; 1(1): 1008.

Case description

A 70-year-old man, with no past medical history, was admit ted to the emergency department (ED) with right upper quad rant (RUQ) abdominal pain, nausea and vomiting for a week. He denied fever, altered bowel movements, or urinary tract symp toms. On observation, he was afebrile, normotensive, tachy cardic and eupneic with oxygen saturation of 99% on room air; cardiopulmonary auscultation was normal and abdomen was depressible, but painful on palpation in right quadrants, with out any mass, swelling, or signs of peritoneal irritation; the re maining examination was unremarkable. Electrocardiography revealed atrial fibrillation with rapid ventricular response (140 beats per minute). Arterial blood gas test excluded significant acid-base or ionic disturbances; lactate 4.1 mmol/L. Laboratory studies showed elevation of inflammatory parameters and a cy tocholestatic pattern with elevated glutamic-oxaloacetic trans aminase (1540 U/L), glutamic-pyruvic transaminase (1194 U/L), alkaline phosphatase (190 U/L), and gamma-glutamyl transfer ase (192 U/L); serum lactate dehydrogenase was also raised (1217 U/L), but with bilirubin at normal range. An abdominal computed tomography (CT) scan revealed hepatomegaly asso ciated with marked parietal thickening of the gallbladder, with out dilatation of the bile ducts (Figure 1a). Though, on CT lung sections, a large volume (26 mm) pericardial effusion was vis ible (Figure 2a) and later confirmed by echocardiography. The patient had successful pericardiocentesis, which yielded about 500 cc of straw-colored pericardial fluid, and whose etiological study was inconclusive. He evolved with clinical, analytical and radiological improvement (Figures 1b and 2b), with resolution of the gallbladder edema, without antibiotic or anti-inflamma tory therapy. At follow-up, no rerecurrence was documented.

Although acute cholecystitis is the most common cause of acute RUQ pain in patients presenting to the ED, in over one third it is attributable to extra-abdominal causes [1,2]. Similarly, gallbladder wall thickening is a radiological feature that often distinguishes acute cholecystitis, but can be seen in several oth er medical conditions [2,3]. This case describes an alternative diagnosis of cholecystopathy, secondary to increased intrahe patic venous pressure caused by pericardial effusion and totally reversible after proper treatment of the primary cause. An ap propriate interpretation of the findings is of great importance, as the correct diagnosis has a direct impact on treatment.

Declarations

Competing interests : None declared.

Authors’ contribution : CPF was involved in drafting the article. MGF and MT were involved in revising the article critically for important intellectual content. All authors read and approved the final manuscript.

Funding sources : The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

References

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