Gallbladder empyema is a clinical diagnosis supported by imaging investigations. Imaging findings on all modalities are not definitive, but suggestive.
Typically the content of the gallbladder is echogenic in keeping with viscous content, with a stone at the gallbladder neck, causing obstruction.
The radiologist has a role in the very ill or patient with co-morbidities in performing drainage with a percutaneous cholecystostomy. This is typically a transhepatic drainage to reduce the incidence of bilious peritonitis.
CT and MRI can aid assessment, particularly to assess for a gallbladder perforation.