Emphysematous cholecystitis

Case contributed by Craig Hacking


Abdo pain and fever

Patient Data

Age: 75-80 years
Gender: Male

Cholelithiasis is present. The gallbladder wall is thickened. Within the anterior wall, there is hyperechogenic curvilinear foci causing dirty shadowing, suggestive of intramural gas. This is seen to move with patient positioning. There is pericholecystic fluid. Sonographic Murphy's sign is positive.

The CBD is dilated (maximal diameter 12mm). No choledocholithiasis appreciated. Normal liver echotexture and echogenicity. No focal liver lesion. The portal and hepatic veins are patent. Ascites is present.


Acute emphysematous cholecystitis. Biliary dilatation without identifiable choledocholithiasis.

Case Discussion

Emphysematous cholecystitis is uncommon and life threatening form of acute cholecystitis. It is also sometimes a complication of severe or untreated acute cholecystitis. It is a surgically emergency  requiring urgent cholecystectomy or cholecystostomy due to a high risk of gallbladder gangrene and / or perforation.

In this case, the acute surgical team were made aware of the findings immediately after the scan. The patient was too unwell with a long list of comorbities for general anesthesia and cholecystectomy and hence went onto to have a US guided cholecystostomy. Bile culture was positive for Klebsiella and Enterobacter species.

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