Point of Care Contrast Enhanced Ultrasound Utility in the Diagnosis of a Gallbladder Perforation: A Case Report

TL;DR

A case report shows how contrast-enhanced ultrasound helped diagnose gallbladder perforation in a cancer patient, avoiding unnecessary surgery.

Contribution

Demonstrates the utility of point-of-care contrast-enhanced ultrasound in diagnosing gallbladder perforation in a metastatic cancer patient.

Findings

Contrast-enhanced ultrasound ruled out tumor infiltration and confirmed gallbladder perforation.

The use of CEUS allowed for conservative management with guided drainage instead of immediate surgery.

CEUS can detect gallbladder wall hypoperfusion and necrosis, predicting potential perforation.

Abstract

We detail the case of a 61-year-old patient with a history of metastatic ovarian cancer who presented to our emergency department (ED) with findings consistent with localized gallbladder perforation and abscess development on an outpatient computed tomography (CT) scan. The differential etiology included primary cholecystitis or infiltrative metastatic mass in the setting of known peritoneal carcinomatosis. Point of care contrast-enhanced ultrasound (CEUS) examination was performed and was able to rule out local tumor infiltration, which was later confirmed by pathology after cholecystectomy. In this case, the identification and confirmation of gallbladder perforation on imaging allowed for more conservative management with image-guided drain placement in a patient who was not an optimal surgical candidate at the time and underwent delayed cholecystectomy. This case report emphasizes the role of CEUS in providing detailed information about gallbladder wall perfusion and integrity with the potential to predict impending gallbladder perforation by demonstrating areas of gallbladder wall hypoperfusion and necrosis as well as visualizing infiltrative lesions.

Figures