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Image of the Month—Quiz Case
Renato Costi, MD, PhD;
Nathalie Bataille, MD;
Alain Cazaban, MD;
Thierry Montariol, MD
Arch Surg. 2009;144(5):481.
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| Since this article does not have an abstract, we have provided the first 150 words of the full text and any section headings. |
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INTRODUCTION
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 appears in full text version.
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Figure 1. Computed tomographic scan (2-dimensional) of the abdomen shows a 5-cm abscess of fourth hepatic segment associated with pneumobilia.
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What Is the Diagnosis?
A.. . . [Full Text of this Article]
Author Affiliations: Service de Chirurgie Viscérale Digestive, Urologique et Plastique, Centre Hôspitalier Intercommunal Poissy/Saint-Germain en Laye, site de St Germain-en-Laye, France (Drs Costi, Bataille, and Montariol); Dipartimento di Scienze Chirurgiche, Università 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).
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Image of the Month—Diagnosis
Arch Surg. 2009;144(5):482.
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