Vague right upper quadrant pain for 1 week. Not systemically unwell.
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The gallbladder wall is thickened and hyperaemic at the neck, but at the body and fundus it is sloughed off and avascular. Small stones and sludge present in the gallbladder. CBD diameter within normal limits for age, with no stones seen in the duct.
Pathologically confirmed gangrenous cholecystitis.
Interestingly, the patient's ultrasound three days prior showed cholelithiasis without gallbladder wall thickening. Even at the time of this scan, he was not particularly sick or tender. This case highlights how clinical presentation and evolution of pathology may be atypical in the elderly patient.