At the time of the initial scan, the patient remained haemodynamically stable, with mild tachycardia and minimally increased oxygen requirements. She was reluctant to undergo any kind of intervention.

After consulting interventional radiology, a triple-phase angiography was performed a few hours after, to confirm possible ongoing hemorrhage, to rule out an underlying vascular pathology in the cystic artery (i.e. pseudoaneurysm), and for eventual vascular planning.

As the following cross-sectional imaging was negative for persistent bleeding or vessel anomaly, no emergency endovascular treatment was recommended. While the white cell count and CRP increased progressively, the hemoglobin remained stable above 120g/L. The patient unfortunately died of complication from sepsis shortly after imaging.

While hemorrhagic changes in the context of gangrenous cholecystitis might be undetected as masked by the clinical response to the underlying gallbladder inflammation, active bleeding is rarely captured on imaging.