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. 2020 Jun 22;7(9):001764.
doi: 10.12890/2020_001764. eCollection 2020.

Intrathoracic Acute Cholecystitis

Giovana Ennis  1 , Gabriela Venade  1 , Joana Silva Marques  1 , Paulo Batista  1 , Ana Abreu Nunes  1 , Júlio Constantino  2 , Luís Costa Matos  1
Affiliations

Intrathoracic Acute Cholecystitis

Giovana Ennis et al. Eur J Case Rep Intern Med. .

Abstract

The authors present the case of a 51-year-old woman with no history of surgical or traumatic injury or accident, who presented with right hypochondrium and epigastric discomfort, malaise, nausea, loss of appetite and episodes of dark urine and greenish stools. Initial laboratory work-up revealed elevated inflammatory markers including leucocytosis with left shift and C-reactive protein, and a slight elevation of gamma-glutamyltransferase and alkaline phosphatase, with no other significant alterations. Computed tomography (CT) showed intrathoracic acute cholecystitis with a large diaphragmatic hernia. A literature search revealed only one other case of acute cholecystitis complicated by intrathoracic gallbladder due to a non-traumatic diaphragmatic hernia. Symptoms are uncharacteristic and the absence of pain or fever, explained by the altered location of the gallbladder, makes the diagnosis a challenge.

Learning points: Only one other case of acute cholecystitis complicated by intrathoracic gallbladder due to a non-traumatic diaphragmatic hernia has been reported.Uncharacteristic symptoms make the diagnosis of intrathoracic acute cholecystitis a challenge.

Keywords: Intrathoracic acute cholecystitis; diaphragmatic hernia; non-traumatic.

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Conflict of interest statement

Conflicts of Interests: The Authors declare that there are no competing interests.

Figures

Figure 1
Figure 1
Computed tomography showing a large right-sided diaphragmatic hernia, with intrathoracic herniation of the right hepatic lobe and gallbladder which is distended, with thickened walls and a large gallstone (18 mm) in the infundibular region. Another gallstone (5 mm) can be identified in the common bile duct
Figure 2
Figure 2
Cholangio-MRI showing the interruption of the diaphragm in the posterolateral region, and a completely intrathoracic right hepatic lobe and gallbladder
See this image and copyright information in PMC

References

    1. Horn CB, Keller J, Gildehaus AJ, Rhee JY. Cholecystitis complicated by intrathoracic gallbladder. J Trauma Acute Care Surg. 2019;87(3):733–734. - PubMed
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