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Prompt Visualization of the Gallbladder with a Rim Sign—Acute or Subacute Cholecystitis?

Department of Radiology, Nuclear Medicine Service, Wilford Hall USAF Medical Center, Lackland AFB, Texas

Correspondence: For correspondence or reprints contact: John C. Morrison, MD, WHMC/SGHRI, 2200 Bergquist Dr., Ste. 1, Lackland AFB, TX 78236-5300.

ABSTRACT

An immunosuppressed, neutropenic patient developed symptoms and signs of acute cholecystitis. Gallbladder ultrasound was consistent with acute cholecystitis. Technetium-99m-diisopropyl iminodiacetic acid (DISIDA) scan showed a rim sign, but with normal gallbladder visualization. On restudy 72 hr later when the patient's WBC count was recovering, the ^99mTc-DISIDA scan again showed a persistent rim sign, but now there was no gallbladder visualization at 1 hr, a pattern strongly predictive for acute complicated cholecystitis. Biliary drainage was performed by percutaneous cholecystotomy with clinical improvement. Semielective cholecystectomy performed 8 wk later confirmed both acute and chronic cholecystitis. We describe the rim sign and its variants, mechanisms of causation, prognostic importance and correlate our report with a review of the literature.

FOOTNOTES

Note: The opinions expressed in this manuscript or those of the author are not necessarily those of the United States Air Force or the Department of Defense.

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