Interactive Transcript
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So this is a seven-year-old male
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with right upper quadrant pain.
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He has an MRI for further evaluation of these findings.
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We'll start off with the T2 non-fat-saturated
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image, scroll through it one time,
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and there's a lot of stuff going on here.
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But I just want to focus on one particular aspect of
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this one abnormality in this patient, and that is going
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to be the finding we see in Morrison's pouch over here.
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So right over here, I'm going to zoom up on it.
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And we'll scroll through this up and down.
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It looks like there is a relatively
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discrete collection over here.
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Internally, it has heterogeneous signal intensity.
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A lot of it is T2 hyperintense, but you
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have these T2 hypointense content as well.
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And some of them again have
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that geographic shape, right?
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Rounded borders, relatively sharp borders.
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The liver surrounding it also has
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that sort of intermediate inflammatory
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T2 signal associated with it.
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So, uh, something that we need to pay attention to.
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We'll look at the T1 pre-contrast image to start,
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and you can already see that there is this T1
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hypointense finding, relatively discrete, uh, just
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a little bit more cephalic to where we've been, uh,
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showing the epicenter of what's going on over here.
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But as we go to that location, you can see
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that there are multiple T1 hypointense
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filling defects within this thick-rimmed collection
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that we see here, and a large one over here as well.
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And so again, we have a case where we have what looks like a
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collection with content that is T1 and T2 hypointense.
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When we give contrast, we can see that this collection
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has a thick rim enhancement associated with it.
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And on different phases of the contrast, we can see some
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of that inflammatory change become a lot more apparent.
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And this happens to be a patient who is also post-
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cholecystectomy, and we're seeing an abscess essentially
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in Morrison's pouch containing content that is T1
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and T2 hypointense with a relatively geographic shape.
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Uh, the top thing on the differential would have to
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be dropped gallstones with an associated abscess.
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And, uh, this is indeed what the patient had.
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And just to show you, in this particular patient,
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the scan from several years prior, as we scroll
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downwards, we can see that there's that one calcified
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gallstone in that location, and a whole cluster
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of calcified gallstones seen in Morrison's pouch.
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And so the first case of dropped
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gallstones we saw was for non-calcified
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gallstones associated with an abscess.
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In this one, we have calcified gallstones
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that over time developed an abscess.
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And for these, uh, particularly when they're of
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this size, that have developed and are causing
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symptoms, you know, these would need to be removed.
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So dropped gallstones in and of
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itself are very symptomatic.
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You don't need to do anything about it.
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Once complications develop, uh, they need to be fixed.
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So the abscesses need to be drained,
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and the nidus causing all that infection
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and complication, which is the gallstones
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themselves, would also need to be removed.
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