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Elevated Right Hemidiaphragm: A Clue in Acute Cholecystitis?
1Department of Internal Medicine, Singapore General Hospital, Singapore, SGP.
Cureus
|June 3, 2021
Summary
Right hemidiaphragm elevation can indicate complicated acute cholecystitis in sepsis patients. Recognizing this sign aids in timely diagnosis and prevents misdiagnosis, improving patient outcomes.
Area of Science:
- Medical Imaging
- Gastroenterology
- Emergency Medicine
Background:
- Sepsis presents with diverse symptoms, complicating diagnosis.
- Acute cholecystitis is a common surgical emergency.
- Right hemidiaphragmatic elevation is an uncommon radiographic finding.
Observation:
- Two sepsis patients presented with vague symptoms and right hemidiaphragmatic elevation on chest X-ray.
- Computed tomography (CT) confirmed complicated acute cholecystitis in both cases.
- Elevation was not due to mass effect or large fluid collections.
Findings:
- Right hemidiaphragmatic elevation can be an early sign of complicated acute cholecystitis.
- This radiographic finding can be present even without significant intra-abdominal collections.
- Misdiagnosis, such as pneumonia, can lead to delayed treatment and patient deterioration.
Implications:
- Clinicians should consider acute cholecystitis in sepsis patients with unexplained right hemidiaphragmatic elevation.
- Radiographic findings should be correlated with clinical presentation for accurate diagnosis.
- Increased awareness of this sign can prevent diagnostic delays and improve management of acute cholecystitis.
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