Li Wenjing, Luo Song
Department of Radiology, Geriatric Hospital of Nanjing Medical University, Nanjing, China.
Department of Radiology, Jiangsu Province Official Hospital, Nanjing, Jiangsu, China.
Radiol Case Rep. 2025 May 30;20(8):4108-4111. doi: 10.1016/j.radcr.2025.05.015. eCollection 2025 Aug.
A 74-year-old male presented to the emergency department with a 5-day history of abdominal pain and fever. Laboratory tests suggested infection and biliary obstruction. Contrast photon-counting computed tomography (PCCT) imaging revealed gallstones, acute cholecystitis, gallbladder perforation, and dilation of the upper segment of the common bile duct, with a suspicion of a potential common bile duct stone (CBDS) that was not visualized. When the energy level was adjusted to 120 keV during postprocessing, a tiny, high-density nodule in the common bile duct became visible. It was further enhanced using a pseudo-colored gallstone template. Surgical exploration confirmed the presence of CBDS. CBDS is often associated with complications such as biliary obstruction, cholangitis, and pancreatitis. In this case, identifying a tiny CBDS after initial contrast imaging suggested that CBDS may have been the underlying cause of the gallbladder perforation. PCCT's multi-energy capabilities played a crucial role in improving diagnostic accuracy and provided clinical insights into the possible cause of the perforation. This case demonstrates the importance of PCCT in diagnosing tiny CBDS, which may change the clinical understanding of gallbladder perforation etiology.
一名74岁男性因腹痛和发热5天就诊于急诊科。实验室检查提示感染和胆道梗阻。对比光子计数计算机断层扫描（PCCT）成像显示有胆结石、急性胆囊炎、胆囊穿孔以及胆总管上段扩张，怀疑存在未显影的潜在胆总管结石（CBDS）。在后处理过程中将能量水平调整至120 keV时，胆总管内一个微小的高密度结节变得可见。使用伪彩色胆结石模板进一步增强显示。手术探查证实存在CBDS。CBDS常伴有胆道梗阻、胆管炎和胰腺炎等并发症。在该病例中，初始对比成像后发现微小的CBDS提示其可能是胆囊穿孔的潜在原因。PCCT的多能量功能在提高诊断准确性方面发挥了关键作用，并为穿孔的可能原因提供了临床见解。该病例证明了PCCT在诊断微小CBDS中的重要性，这可能会改变对胆囊穿孔病因的临床认识。
