Reens David, Podgorski Beata
Department of Emergency Medicine, Huntington Hospital, Huntington, New York.
J Emerg Med. 2019 Jul;57(1):74-76. doi: 10.1016/j.jemermed.2019.03.010. Epub 2019 Apr 15.
Hemorrhagic cholecystitis is a rare complication of acute cholecystitis and is a potentially fatal diagnosis. It may be difficult to detect because the symptoms are similar to more common diagnoses. Point-of-care ultrasound is a useful imaging technique in the emergency setting and is readily available to allow for immediate interpretation and application of the results to guide medical decision making.
We report a 76-year-old man with a history of hypertension, hyperlipidemia, diabetes, atrial fibrillation on warfarin, and coronary artery disease presenting with epigastric pain radiating to the back, nausea, and vomiting who was found to have hemorrhagic cholecystitis with gallbladder perforation. Ultrasound of the abdominal right upper quadrant showed a large, hyperechoic, nonshadowing, globular structure visualized within the lumen of the gallbladder extending from the neck through the body. The gallbladder wall was noted to be 0.72 cm with wall edema, focal pericholecystic fluid, and a positive sonographic Murphy sign suggestive of acute cholecystitis. The abnormal appearance of the gallbladder contents was suspected to be blood. Computed tomography angiography was performed and confirmed the diagnosis of acute hemorrhagic cholecystitis with perforation. Blood was noted to track from the cystic duct to the gallbladder lumen. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: To our knowledge, this is a unique case of hemorrhagic cholecystitis visualized on bedside ultrasound. This case shows that the use of point-of-care ultrasound by emergency medicine providers can facilitate the rapid recognition and treatment of specific, life-threatening hepatobiliary pathology while excluding alternate diagnoses.
出血性胆囊炎是急性胆囊炎的一种罕见并发症，是一种潜在的致命诊断。由于其症状与更常见的诊断相似，可能难以检测。床旁超声是急诊环境中一种有用的成像技术，可随时进行检查，以便立即解读结果并应用于指导医疗决策。
我们报告一名76岁男性，有高血压、高脂血症、糖尿病、正在服用华法林的心房颤动和冠状动脉疾病史，出现上腹部疼痛并放射至背部、恶心和呕吐，被发现患有伴有胆囊穿孔的出血性胆囊炎。右上腹超声显示胆囊腔内有一个大的、高回声、无阴影的球形结构，从胆囊颈部延伸至体部。胆囊壁厚度为0.72 cm，伴有壁水肿、胆囊周围局限性液性暗区，超声墨菲氏征阳性，提示急性胆囊炎。怀疑胆囊内容物的异常表现为血液。进行了计算机断层血管造影，证实了急性出血性胆囊炎伴穿孔的诊断。可见血液从胆囊管流向胆囊腔。
急诊医生为何应了解此情况？据我们所知，这是一例在床旁超声检查中发现的出血性胆囊炎独特病例。该病例表明，急诊医学人员使用床旁超声可有助于快速识别和治疗特定的、危及生命的肝胆疾病，同时排除其他诊断。
