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 (Ref: Sabiston 19/e p1440-1447, 1487-1488; Schwartz 9/e p1115 -1116; style="font-size: 1.04761904761905em; font-family: Times New Roman, Times, serif">)Causes of Elevated HemidiaphragmAbove the diaphragmDiaphragmBelow the DiaphragmDecreased lung volume:* Atelectasis/collapse* Lobectomy/pneumonectomy* Pulmonary hypoplasia* Phrenic nerve palsy* Diaphragmatic eventration* Contralateral CVA: usually MCA distribution* Abdominal tumour* Subphrenic abscess* Liver abscess (Amebic and pyogenic)Radiological findings of Acute CholecystitisUSG findings: Presence of gallstones, thickening of the GB wall (>4 mm), pericholecystic fluid, GB distention, impacted stone, and a sonographic Murphy's signQ (focal tenderness directly over the GB).USG: IOC for diagnosing acute cholecystitisQ (sensitivity 85%, specificity 95%).HIDA scan: Gold standardQ for diagnosing acute cholecystitisHIDA scan: No filling of GB with the radiotracer (99mTc-HIDA) after 4 hours indicates an obstructed cystic ductQA normal HIDA scan excludes acute cholecystitisQ.
Hepatic Tumors, Cysts, and Abscesses