A middle aged patients present with the complained of right hypochondrial pain. On X-ray, elevated right hemidiaphragm was seen. All of the following are the possible diagnoses except
Subphrenic abscess
Acute cholecystitis
Pyogenic liver abscess
Amoebic liver abscess in right lobe
Ans. b. Acute cholecystitis Causes of Elevated Hemidiaphragm Above the diaphragm Decreased lung volume: Atelectasis/collapse Lobectomy/pneumonectomy Pulmonary hypoplasia Diaphragm Phrenic nerve palsy Diaphragmatic eventration Contralateral CVA:usually MCA distribution Below the Diaphragm Abdominal tumour Subphrenic abscess Liver abscess (Amebic and pyogenic) Radiological findings of Acute Cholecystitis USG findings: Presence of gallstones, thickening of the GB wall (>4 mm), pericholecystic fluid, GB distention USG: IOC for diagnosing acute cholecystitisQ (sensitivity 85%, specificity 95%). HIDA scan: Gold standarddeg for diagnosing acute cholecystitis HIDA scan: No filling of GB with the radiotracer (99mTc-HIDA) after 4 hours indicates an obstructed cystic ductQ