Interactive Transcript
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So the next patient is an 80-year-old female.
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History provided is abnormal liver function tests.
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And so they got an MRI of the abdomen with
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or without intravenous contrast with MRCP
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to evaluate the etiology of these findings.
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So again, lots of stuff going on in this patient.
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However, we're going to focus on the gallbladder.
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And as we focus on the gallbladder, we can see that
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this gallbladder looks very distended, much more
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distended than we've seen in some of the prior cases.
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And so that automatically gets us
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worried that there's some sort of
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potential inflammatory process going on.
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So let me just scroll through it one time and then
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go through some of the other findings we see here.
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Small gallstone, another small gallstone that we just
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passed through. T2 hypointense and sort of a rounded shape.
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I want to start going slowly through this area
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here and we can see that there's a bunch of cysts.
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But also, if we were to follow the wall of
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this gallbladder, it looks pretty consistent
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over here, present, maybe thins out a little
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bit here, present here again, but from
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here to here, it looks like there's a gap.
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Not only is there a gap, but it looks like there
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is this hyperintense T2 content, essentially the
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bile that's spilling out through this gap over here.
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And so that's going to become worrisome for us.
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And I'll tell you a little bit
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about what that could mean.
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Besides the gallbladder distension,
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there's a lot of inflammation here.
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Again, it would be better appreciated on some of the
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T2-weighted saturated images, but there's a lot of edema
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and fluid that's surrounding this gallbladder.
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So this gallbladder really is inflamed, but on top of
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that, it looks like a portion of the wall is missing.
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And not only is a portion of the wall
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missing, but there's actual internal
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content within the gallbladder, i.e., the bile
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42 00:01:45,470 --> 00:01:46,250
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that's spilling out through this area.
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Let's see some of the findings on the coronal image.
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The gallbladder distension, I think, is
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again nicely appreciated, at least in the
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longitudinal dimension on the coronal images.
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You can see some of the gallstones over here.
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That focal area of gallbladder
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discontinuity is present over here.
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It's a little bit harder to appreciate on the coronals.
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I'll move on to the post-contrast images.
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A little bit of motion here; however, we can still
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evaluate that area of gallbladder wall discontinuity,
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sort of along the inferior aspect of the gallbladder
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where there's just an area that's missing.
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The gallbladder wall is not enhancing
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in this area, and bile is spilling out.
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So this is another complication that we
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can see with acute cholecystitis, and
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it's known as perforated cholecystitis.
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And so, you know, you can have acute
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cholecystitis over time; the wall can become
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necrotic and you get gangrenous cholecystitis.
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And really as a continuum of that, when a wall
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becomes necrotic, you have content that then spills
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out of that wall into the adjacent soft tissue.
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That's when we call it perforated cholecystitis.
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Oftentimes, these are so discrete abscesses.
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We'll see what that looks like
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in some of the other cases.
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And when you do see this, often, you know, you'll
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have to do a cholecystostomy. If there's an abscess,
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you're going to have to drain that abscess.
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You're not going to go ahead and take this
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gallbladder out immediately; you're going to
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sort of allow it to cool off a little bit.
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And proceed with cholecystectomy
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when it's clinically feasible.
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So again, this is just another complication
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that we can see with acute cholecystitis when
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you start to have gangrene of the wall and
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now we call it gangrenous cholecystitis.
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And as a result of that, you
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have gallbladder contents that are now spilling
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out to that area of necrotic gallbladder wall.
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We start to call it perforated cholecystitis.
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