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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).



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).