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Perforated GB

12/28/11 - This week's image of the week is brought to us by Drs. Martinez and Akhter who diagnosed a perforated cholecystitis in the Emergency Department.

The patient's ultrasound showed evidence of acute cholecystitis, and RUQ free fluid.  These images can also teach us an important lesson about improving the sensitivity of our FAST exams in the ED.  This patient had a very small amount of free fluid collected at the inferior tip of the liver (in this case bile not blood).  The inferior tip of the liver is actually the most dependant portion of the RUQ and fluid will collect here first before it collects in Morrison's pouch.  It is important to fan all the way back and forth though the entire body of the kidney when performing the FAST to make sure you dont miss this key area.  

Watch the Video.  Below are two labeled still images from the video. 

ff at the liver tip

Thanks for all your great images... and happy holidays!