Presentation
Right upper quadrant pain.
Patient Data
Dilated gallbladder with mild wall thickening and surrounding stranding. The fundus slightly indents the anterior abdominal wall (tensile fundus sign) - notice in particular on the sagittal reformats.
Case Discussion
Tensile fundus sign is a very helpful indicator of acute cholecystitis, and generally is a subtle indentation of the anterior abdominal wall due to the higher intraluminal pressures of the obstructed gallbladder. Notice how the wall thickening and stranding are relatively subtle, but with the addition of the tensile fundus the diagnosis of acute cholecystitis can be made confidently. Also consider the lack of necessity due to any further testing (such as RUQ US) as no additional helpful information will be gained (except perhaps the presence of gallstones). This diagnosis was confirmed at surgery.
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