Can cholecystitis present with a hematoma-like lesion in the left lower abdomen?

Cholecystitis and Left Lower Abdominal Hematoma-Like Lesions

Cholecystitis typically does not present with a hematoma-like lesion in the left lower abdomen, as the gallbladder is located in the right upper quadrant of the abdomen. 1

Typical Presentation of Cholecystitis

• Cholecystitis classically presents with right upper quadrant and/or epigastric pain that may radiate to the upper back or right infrascapular area 2
• Pain episodes typically last from 30 minutes to several hours or even up to a day 2
• Other common symptoms include anorexia and sometimes fever, particularly if inflammation is significant 2
• The primary imaging findings are located in the right upper quadrant, not the left lower abdomen 1

Imaging Findings in Cholecystitis

• Ultrasound is the first-line imaging test for suspected gallbladder disease with 96% accuracy for detecting gallstones 2
• Typical findings include gallbladder wall thickening, pericholecystic fluid, and sonographic Murphy sign 1, 2
• CT findings include gallbladder wall thickening, pericholecystic inflammation, and adjacent liver parenchymal hyperemia (if IV contrast is used) 1
• MRI may show gallbladder wall thickening with T2 signal hyperintensity in acute cholecystitis 1

Hemorrhagic Complications of Cholecystitis

• Hemorrhagic cholecystitis is a rare, life-threatening complication that can lead to bleeding within the gallbladder lumen or wall 3, 4
• Bleeding is typically contained within the gallbladder or may extend to the gallbladder fossa and right paracolic gutter, not the left lower abdomen 3
• Risk factors for hemorrhagic cholecystitis include anticoagulation therapy, trauma, malignancy, renal failure, and cirrhosis 5, 6
• CT findings in hemorrhagic cholecystitis include hyperdense material within the gallbladder lumen 4

Differential Diagnosis for Left Lower Abdominal Hematoma-Like Lesions

• A hematoma-like lesion in the left lower abdomen is more likely to be associated with:
  • Diverticular disease with bleeding 1
  • Trauma to the left lower quadrant 1
  • Vascular lesions or aneurysms 1
  • Tumors with hemorrhage 7
  • Complications of anticoagulation therapy unrelated to the gallbladder 5, 4

Rare Cases of Gallbladder Pathology with Distant Hematoma

• While intramural gallbladder hematomas have been reported, they typically present as gallbladder masses rather than distant left lower quadrant lesions 7
• In cases of gallbladder rupture with massive intra-abdominal hemorrhage, bleeding may extend beyond the right upper quadrant, but this is an extremely rare and life-threatening scenario 3

Diagnostic Approach

• For a patient presenting with a hematoma-like lesion in the left lower abdomen:
  • Ultrasound is the initial imaging modality of choice to evaluate both the gallbladder and the left lower quadrant 1, 2
  • If ultrasound is inconclusive, CT with IV contrast would be the next appropriate imaging study 1
  • MRI may provide additional characterization if the diagnosis remains unclear 1

In conclusion, while cholecystitis can rarely present with hemorrhagic complications, these typically manifest in the right upper quadrant. A hematoma-like lesion in the left lower abdomen is highly unlikely to be directly related to cholecystitis and warrants investigation for alternative diagnoses.