LAST CHANCE: X-ray Interpretation: Elbow Injuries - Half price course offer ends this Sunday!

Acute acalculous cholecystitis

Case contributed by Dr Bruno Di Muzio


Post bone marrow transplant for myelodysplastic syndrome. Febrile, rigors, epigastric tenderness with voluntary guarding. Mild suprapubic pain. Nausea, vomiting and diarrhea 24 hours.

Patient Data

Age: 60 years
Gender: Female

CT Abdomen (selected images)

A moderate amount of pericholecystic free fluid surrounding the gallbladder with mural enhancement and surrounding fat stranding. No free gas to suggest perforation. No cholelithiasis identified. The gallbladder is not distended. No intrahepatic or extrahepatic bile duct dilatation. No portal vein thrombosis identified. The liver, pancreas, adrenals, kidneys, bladder, small and large bowel are unremarkable. 


US Liver and Bliary tree

The liver has normal sonographic appearances, with no evidence of focal lesions or intrahepatic biliary dilatation. The gallbladder demonstrates ill-defined wall thickening and surrounding fat stranding; small calcification present within the gallbladder wall. No evidence of gallstones. The common biliary duct measures up to for millimeters in caliber. The pancreas was obscured by overlying bowel gas.

Case Discussion

The features of both CT and ultrasound are those of cholecystitis with no gallstones identified, in keeping with acute acalculous cholecystitis.

Blood tests: 

  • GGT 81H IU/L
  • ALT 55H IU/L
  • AST 128H 
  • Bili Total 19 umol/L (ref <21)
PlayAdd to Share

Case information

rID: 48250
Published: 27th Sep 2016
Last edited: 7th Jul 2020
Tag: rmh
Inclusion in quiz mode: Included

Updating… Please wait.

 Unable to process the form. Check for errors and try again.

 Thank you for updating your details.