Gallbladder empyema

Case contributed by Dr Ian Bickle

Presentation

Known gallstone disease awaiting elective cholecystectomy. Represents with RUQ pain.

Patient Data

Age: 70
Gender: Male
Ultrasound

Indistinct gallbladder wall, with the suspicion of a defect on the hepatic aspect.  The gallbladder is full of echogenic material, suggestive of an empyema.

MRI

The gallbladder is diffusely thick walled with an obstructing stone in the neck, resulting in a distended gallbladder.

The wall on the hepatic aspect is sloughing off, although the outer aspect is intact - not perforated as the prior ultrasound suggested.

Case Discussion

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.

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Case information

rID: 21751
Case created: 15th Feb 2013
Last edited: 17th Jun 2016
Inclusion in quiz mode: Included

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