COVID-19 associated spontaneous hemorrhagic cholecystitis

Abstract

Hemorrhagic cholecystitis is a rare disorder associated with considerable morbidity and mortality. The clinical presentation of hemorrhagic cholecystitis is non-specific and imaging findings can be difficult to accurately interpret without a high level of suspicion. Most recent reports of hemorrhagic cholecystitis have been associated with concurrent therapeutic anticoagulation. Here, we report imaging findings of a case of acute, spontaneous hemorrhagic cholecystitis in a 67-year-old male patient admitted for hypoxic respiratory failure secondary to COVID-19 pneumonia.

Keywords: COVID-19; Gallbladder; Hemobilia; Hemorrhagic cholecystitis; SARS-CoV-2.

Fig. 1

Contrast enhanced computed tomography images of the chest. (A and B) Axial and coronal projection images in lung windows demonstrating bilateral mosaic attenuation with peripheral predominant ground-glass opacities in the background of upper lobe predominant centrilobular and paraseptal emphysema. (C and D) Axial images in pulmonary angiogram windows demonstrating hypoattenuating filling defects in the subsegmental pulmonary arteries of the left upper lobe (arrows).

Fig. 2

Right upper quadrant ultrasound. (A) Grayscale image demonstrating a distended gallbladder with layering echogenic intraluminal material (arrow). (B) Color Doppler image without evidence of abnormal flow within the gallbladder lumen.

Fig. 3

Contrast enhanced axial projection computed tomography images of the upper abdomen. (A) Distended gallbladder with layering hyperattenuating luminal debris (white arrow). (B) Portal venous image demonstrating contrast material extravasation (black arrow) into the gallbladder lumen. (C) Inflammatory fat stranding near the gallbladder fundus (dashed white arrow). (D) Appearance of the gallbladder (GB) 1 year prior.