Abstract
A 68-year-old Japanese woman diagnosed as having a gall-bladder tumor was admitted to our department. Laboratory findings at admission were as follows : serum CEA, 1.3 ng/mL ; serum CA19-9, 26.5 U/mL ; WBC count, 23920/μL ; serum CRP, 9.14 mg/dL ; serum total bilirubin, 1.0 mg/dL ; serum AST, 33 IU/L ; serum ALT, 16 IU/L ; PT, 62% ; serum TAT, 6.9 ng/mL ; serum fibrinogen, 435 mg/dL ; serum D-dimer, 9.8 μg/mL ; serum AT-III, 98%. MRI and dynamic CT revealed a gall-bladder tumor measuring 2 cm in diameter, dynamic CT revealed a portal venous embolus, and PET-CT showed high accumulation of FDG in the paraaortic lymph nodes, portal venous embolus, and gall-bladder. We diagnosed the patient as having advanced gall-bladder cancer with a portal venous tumor embolus, and lymph node metastasis. After admission, the patient developed acute chronic cholecystitis, and we performed emergent cholecystectomy. Histopathological examination revealed that the lesion was, in fact, not a neoplasm, but a fibrin clot ; therefore, we corrected our diagnosis to cholecystitis with portal venous thrombosis. With administration of heparin and edoxisaban, the portal venous thrombus resolved. Acalculous cholecystitis without cholangitis rarely causes portal venous thrombosis. Although only 20 cases have been reported, clinicians should bear in mind the possibility of acalculous cholecystitis with portal venous thrombosis even in cases where the lesion shows enhanced uptake on PET-CT.
