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
Modality: 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.

Modality: 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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