Presentation
Right upper quadrant pain with a history of choledocholithiasis.
Patient Data
there is a paracaval fat seeming to invaginate into the medial intrahepatic segment of the inferior vena cava, in keeping with paracaval lipoma
mild gallbladder distension with diffuse thickening of the gallbladder wall, pericholecystic free fluid and fat-stranding. Several partially-obstructive gallstones located in the neck of the gallbladder and in the cystic duct, in keeping with acute calcular cholecystitis
the portal and hepatic veins are normal
Paracaval lesion demonstrating hyperintense T1 and T2 signals without a drop on out-of-phase imaging. However, there is a drop of signal on T1 dixon water images.
Case Discussion
Paracaval lipomas are not that uncommon and are reported to be seen in up to 0.5% of CT examinations 1.
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