Gallbladder Fossa Abscess Masquerading as Cholecystitis After Cholecystectomy

Area of Science:

• Radiology
• Nuclear Medicine
• Hepatobiliary Imaging

Background:

• Cholecystectomy is a common surgical procedure.
• Postoperative complications can occur, including abscess formation.
• Accurate diagnosis of intra-abdominal abscesses is crucial for patient management.

Observation:

• A 59-year-old woman presented with a suspected abscess in the gallbladder fossa after cholecystectomy.
• A hepatobiliary scan utilizing technetium-99m diisopropyliminodiacetic acid ((99m)Tc-DISIDA) was performed.
• The scan revealed a unique finding: the
• rim sign
• – a central photopenic defect bordered by increased radiotracer uptake.

Findings:

• The observed
• rim sign
• was directly adjacent to the gallbladder fossa.
• This pattern is indicative of reactive inflammation in the surrounding hepatic parenchyma.
• The findings suggest the presence of a subhepatic or intrahepatic abscess secondary to the cholecystectomy.

Implications:

• The
• rim sign
• on hepatobiliary scintigraphy can be a valuable diagnostic indicator for postoperative gallbladder fossa abscesses.
• This imaging finding aids in differentiating abscesses from other postoperative fluid collections.
• Early and accurate diagnosis facilitated by this sign can lead to timely intervention and improved patient outcomes.