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Special Feature
May 18, 2009

Image of the Month—Quiz Case

Author Affiliations

Author Affiliations:Service de Chirurgie Visc[[eacute]]rale Digestive, Urologique et Plastique, Centre H[[ocirc]]spitalier Intercommunal Poissy/Saint-Germain en Laye, site de St Germain-en-Laye, France (Drs Costi, Bataille, and Montariol); Dipartimento di Scienze Chirurgiche, Universit[[agrave]] di Parma, Parma, Italia (Dr Costi); and Service de Radiologie, CHI Poissy/Saint-Germain en Laye, site de St Germain-en-Laye, France (Dr Cazaban).




Copyright 2009 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Restrictions Apply to Government Use.2009

Arch Surg. 2009;144(5):481-482. doi:10.1001/archsurg.2009.64-a

An otherwise healthy 68-year-old white man presented with a 4-day history of hyperthermia, a 6/10 dull pain (analogic pain scale) at the right superior abdominal quadrant, and nausea. Physical examination revealed a temperature of 40.1°C and mild right subcostal tenderness without rebound. Laboratory testing showed a perturbation of hepatic enzymes, an alteration of renal function, and an elevated white blood cell count. Ultrasound revealed the presence of gallbladder stones and of a round hypoechogenic image in the fourth hepatic segment 5 cm in diameter; a computed tomographic (CT) scan of the abdomen confirmed the presence of a hypodense image in the liver and revealed the presence of gas in the gallbladder (Figure 1).

Figure 1
Image not available

. Computed tomographic scan (2-dimensional) of the abdomen shows a 5-cm abscess of fourth hepatic segment associated with pneumobilia.

What Is the Diagnosis?

A. Hepatocellular carcinoma infiltrating the intrahepatic biliary tree

B. Cholecystocolonic fistula associated with hepatic abscess

C. Echinococcus hydatid associated with acute cholecystitis by anaerobic bacteria

D. Posttraumatic hepatic hematoma and pneumobilia