A Case of Perforated Cholecystitis Presenting as Persistent Pleural Effusion

Abstract

Gallbladder perforation is an uncommon complication of cholecystitis that can result in perihepatic abscess. We present a case of persistent right-sided pleural effusion secondary to perihepatic abscess from perforated gallbladder. A 46-year-old male with paraplegia secondary to T4 spinal cord injury was admitted after presenting with fever, cough, and shortness of breath. He had previously been treated at an outside hospital with an oral antibiotic course for a presumed pneumonia. CT chest showed a large rightsided pleural effusion. A pleural pigtail catheter was placed with persistent large-volume output. Initial imaging of the chest incidentally revealed a large peri-hepatic fluid collection. This was further investigated with an abdominal CT which revealed a large perihepatic rim-enhancing fluid collection with multiple gallstones in the gallbladder neck and small collections in the gallbladder fundus suspicious for a site of perforation. He was sent for interventional-radiology guided drain placement with plan for outpatient cholecystectomy. Output from the pleural pigtail decreased and the drain was removed with resolution of sepsis and shortness of breath. Gallbladder perforation is a relatively infrequent complication of acute cholecystitis. Often, intial symptoms of cholecystitis are masked due to uncontrolled diabetes or, as in this case, spinal cord injury. As far as the authors of this case are aware, perforated gallbladder resulting in pleural effusion has not yet been described in the literature.2921 Figure 1. Perihepatic abscess