Özüm TUNÇYÜREK, Elif ÇETİNKAYA, Aslı KURU

A Gallbladder Mercedes-Benz Sign in Acute Hepatitis A

Yirmi altı yaşındaki erkek olgu acil servise karın ağrısı, ateş, bulantı ve kusma yakınması ile başvurdu. Karın ağrısı ve mide bulantısı yakınmaları ile yoğun bakımda takibe alınan olgunun abdominal ultrason tetkikinde karaciğer sağ lob uzun aksı 140 mm bulundu. Karaciğer hilusunda 1,5 cm'lik lenfadenopati mevcuttu. Olgu bilgisayarlı tomografi (BT) tetkiki ile incelendi. Portal venöz faz kontrastlı BT incelemesinde, safra kesesi duvar kalınlığı 8 mm olup, perikolesistik ve pelvik serbest sıvı saptandı. Yapılan biyokimyasal testler sonrasında olgu akut hepatit A tanısı aldı. Bu olguda ilginç olan bulgu BT tetkikinde literatürde ilk kez tanımlanacak olan safra kesesi duvarında izlenen Mercedes Benz işaretidir.

Akut Hepatit A Olgusunda Safra Kesesinde Mercedes-Benz İşareti

A 26-year-old male presented to the emergency department with the complaints of abdominal pain, fever, nausea and vomiting. During the abdominal ultrasound examination of the patient, who was taken to the intensive care unit due to stomach ache and nausea, the size of the long axis of the right lobe of the liver was found to be 140 mm. An about 1.5-cm lymphadenopathy was detected in the hilum. On portal venous phase-enhanced computed tomography (CT), the gallbladder wall thickness was 8 mm and pericholecystic and pelvic fluids were observed. Following biochemical tests, the patient was diagnosed with acute hepatitis A. In this case, it was an interesting finding that the gallbladder wall took the form of a MercedesBenz sign observed on CT, as a finding of hepatitis A for the first time in the literature.

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Yoo SM, Lee HY, Song IS, Lee JB, Kim GH, Byun JS. Acute hepatitis A: correlation of CT findings with clinical phase. Hepatogastroenterology 2010; 57: 1208-14.
Zissin R, Osadchy A, Shapiro-Feinberg M, Gayer G. CT of a thickened-wall gall bladder. Br J Radiol 2003; 76: 137-43.
Park SJ, Kim JD, Seo YS, Park BJ, Kim MJ, Um SH, et al. Computed tomography findings for predicting severe acute hepatitis with prolonged cholestasis. World J Gastroenterol 2013; 19: 2543- 9.
Maresca G, De Gaetano AM, Mirk P, Cauda R, Federico G, Colagrande C. Sonographic patterns of the gallbladder in acute viral hepatitis. J Clin Ultrasound 1984; 12: 141-6.
van Breda Vriesman AC, Engelbrecht MR, Smithuis RH, Puylaert JB. Diffuse gallbladder wall thickening: differential diagnosis. AJR Am J Roentgenol 2007; 188: 495-501.
Kim MY, Baik SK, Choi YJ, Park DH, Kim HS, Lee DK, et al. Endoscopic sonographic evaluation of the thickened gallbladder wall in patients with acute hepatitis. J Clin Ultrasound 2003; 31: 245-9.
Suk KT, Kim CH, Baik SK, Kim MY, Park DH, Kim KH, et al. Gallbladder wall thickening in patients with acute hepatitis. J Clin Ultrasound 2009; 37: 144-8.
Black MM, Mann NP. Gangrenous cholecystitis due to hepatitis A infection. J Trop Med Hyg 1992; 95: 73-4.
Kaya S, Eskazan AE, Ay N, Baysal B, Bahadir MV, Onur A, et al. Acute acalculous cholecystitis due to viral hepatitis A. Case Rep Infect Dis 2013; 2013: 407182.
Casha P, Rifflet H, Renou C, Bulgare JC, Fieschi JB. Acalculous acute cholecystitis and viral hepatitis A. Gastroenterol ClinBiol 2000; 24: 591-2.
Portincasa P, Moschetta A, Di Ciaula A, Palmieri VO, Milella M, Pastore G, et al. Changes of gallbladder and gastric dynamics in patients with acute hepatitis A. Eur J Clin Invest 2001; 31: 617-22.