Right upper quadrant pain and fever in a 47-year-old woman
History
47-year-old woman with 30 h of constant right upper quadrant pain, temperature 38.1 °C, white cell count 14.8 × 10⁹/L, normal bilirubin. Ultrasound: gallstones, gallbladder wall 3.5 mm, equivocal sonographic Murphy’s sign, no duct dilatation. Fasted 6 h; no opioids since admission. Request: acute cholecystitis?
Step 1 · The first hour
The liver takes up tracer promptly and the common bile duct and bowel are seen by 30 min, but at 60 min the gallbladder has not been seen. What is the best next step?