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This is an MRCP in a patient who presented

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in the second trimester of pregnancy

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with right upper quadrant abdominal

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pain and abnormal liver function tests.

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The patient has a history of chronic

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hepatitis B, and when we look at the axial

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T2-weighted images of the abdomen, one of the

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first things that we notice is increased T2

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signal around the portal venous vasculature.

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This is periportal edema, and although it's a

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nonspecific finding, it's certainly not normal.

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The second thing I'd like to point out for this

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patient is the appearance of the gallbladder.

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This is the lumen of the gallbladder here.

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This is the gallbladder wall.

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So the gallbladder is extremely thickened, but

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not particularly distended for this patient.

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The other thing that I'll point out is there

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is really no significant pericholecystic

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fluid present on this examination.

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When we look at the MRCP images, we can

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see that the common bile duct is normal

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in caliber, and there's no significant

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intrahepatic biliary ductal dilation.

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We see a partial view of the cephalic

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presentation fetus on these highly

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fluid-sensitive sequences as well.

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I'd like to also show the diffusion

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weighted images and corresponding

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ADC map for this patient.

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And so when we look at the

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diffusion weighted images,

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we can see that there is high signal

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within the region of the gallbladder,

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which is also present on the ADC.

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So this is T2 shine through and not true

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diffusion restriction, which leads us

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to conclude that the thickening of the

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gallbladder is likely reactive rather than

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reflective of acute gallbladder pathology.

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When this patient was interviewed further, it

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was disclosed that she had had acute flu

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like symptoms for the past week and had been

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medicating herself with high-dose Tylenol.

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And so, this is a case of acute hepatitis

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with reactive gallbladder wall thickening

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in the setting of Tylenol overdose.