RT Journal
A1 Costi R, Bataille N, Cazaban A, Montariol T
T1 IMage of the month—quiz case
JF Archives of Surgery
JO Archives of Surgery
YR 2009
FD May 18
VO 144
IS 5
SP 481
OP 482
DO 10.1001/archsurg.2009.64-a
UL http://dx.doi.org/10.1001/archsurg.2009.64-a
AB 
An otherwise healthy 68-year-old white man presented with a 4-day history of hyperthermia, a 6/10 dull pain (analogic pain scale) at the right superior abdominal quadrant, and nausea. Physical examination revealed a temperature of 40.1°C and mild right subcostal tenderness without rebound. Laboratory testing showed a perturbation of hepatic enzymes, an alteration of renal function, and an elevated white blood cell count. Ultrasound revealed the presence of gallbladder stones and of a round hypoechogenic image in the fourth hepatic segment 5 cm in diameter; a computed tomographic (CT) scan of the abdomen confirmed the presence of a hypodense image in the liver and revealed the presence of gas in the gallbladder (Figure 1).