Abstract
An 18-year-old female presented to the emergency department (ED) with two days of right lower quadrant pain and associated nausea and emesis. After relevant information was gathered and with physical exam findings of a tender right lower quadrant, positive psoas sign, positive Rovsing sign, and pain with right heel tap, the patient was presumed to have appendicitis. However, imaging contradicted the initial leading diagnosis and revealed a markedly distended, hydropic gallbladder with its tip near the umbilicus. Findings of the distended gallbladder with marked wall thickening and pericholecystic fat stranding and edema confirmed acute cholecystitis, and the patient was taken by general surgery for cholecystectomy. Together, this unusual presentation and this unexpected diagnosis shine light upon another facet of the hydropic gallbladder while also serving as a salient reminder to contemplate a broad differential regardless of seemingly classic presentations of illnesses. TOPICS: Cholecystitis, hydropic gallbladder, abdominal pain, appendicitis.