A 67 year old female with history of CVA, presented from a nursing home with RUQ abdominal pain and inablitiy to tolerate PO for 3 days. A CT scan of her abdomen was obtained. What is the diagnosis ?
1- Cholecystitis
Ultrasound remains the best modality to test for cholecystitis. However, CT scans can still be obtained for non-classic presentations. The negative predictive value of CT is still relatively high. CT has a negative predictive value of 89%, compared to 97% to that of ultrasound. The absence of cholecysitis on CT will help the argument against the diagnosis, but if the suspicion is high an ultrasound study should still be obtained.
Things to look for on an abdominal CT that are suggestive of cholecysitis:
Gallbladder distension ( >5 cm width, >8 cm length).
Wall thickening ( >4mm thickness).
Pericholecystic fat stranding.
Presence of gallstones.
2- An inflated foley catheter in the ureter!
Ureteric insertion of foley catheters is a very rare complication of foley catheterization. There are no clear predisposing factors to this complication. However, it is thought that the presence of an underlying anatomical deformity (e.g. abnormal ureteric insertion site) might put the patient at a higher risk for it. Inflating a balloon in the ureter might result in severe ureteric injury. A suggested method to prevent this kind of injury is to perform bladder aspiration to insure balloon positioning prior to inflation.
References
1- Shakespear, Jonathan S., Akram M. Shaaban, and Maryam Rezvani. "CT findings of acute cholecystitis and its complications." American Journal of Roentgenology 194.6 (2010): 1523-1529.
2- Kim, Myung Ki, and Kwangsung Park. "Unusual complication of urethral catheterization: a case report." Journal of Korean medical science 23.1 (2008): 161.
