A middle aged patients present with the complained of right hypochondrial pain. On X-ray, elevated right hemidiaphragm was seen. All of the following are the possible diagnoses except?
Ans. b. Acute cholecystitis (Ref: Sabiston 19/e p1440-1447, 1487-1488; Schwartz 9/e p1115 -1116; style="font-size: 1.04761904761905em; font-family: Times New Roman, Times, serif">)Causes of Elevated HemidiaphragmAbove the diaphragmDiaphragmBelow the DiaphragmDecreased lung volume:* Atelectasis/collapse* Lobectomy/pneumonectomy* Pulmonary hypoplasia* Phrenic nerve palsy* Diaphragmatic eventration* Contralateral CVA: usually MCA distribution* Abdominal tumour* Subphrenic abscess* Liver abscess (Amebic and pyogenic)Radiological findings of Acute CholecystitisUSG findings: Presence of gallstones, thickening of the GB wall (>4 mm), pericholecystic fluid, GB distention, impacted stone, and a sonographic Murphy's signQ (focal tenderness directly over the GB).USG: IOC for diagnosing acute cholecystitisQ (sensitivity 85%, specificity 95%).HIDA scan: Gold standardQ for diagnosing acute cholecystitisHIDA scan: No filling of GB with the radiotracer (99mTc-HIDA) after 4 hours indicates an obstructed cystic ductQA normal HIDA scan excludes acute cholecystitisQ.
Subphrenic abscess
Acute cholecystitis
Pyogenic liver abscess
Amoebic liver abscess in right lobe
Hepatic Tumors, Cysts, and Abscesses