EURORAD ESR

Case 13654

A case of complicated emphysematous cholecystitis

Author(s)
Arcidiacono A., Martino L., Morcaldi D., Rosa F., Siffredi O., Gandolfo N.

Villa Scassi Hospital,
Genoa, Italy
 
Patient
male, 59 year(s)
 
 
  • Figure 1
    Direct abdominal X-ray

    Note the oval finding with an air-fluid level inside and a thin peripheral rim of radiolucency in the right upper abdominal quadrant.

     
    Area of Interest: Abdomen; Imaging Technique: Conventional radiography; Procedure: Diagnostic procedure; Special Focus: Ischaemia / Infarction;
     
     
  • Figure 2
    Abdominal ultrasound
     

    Highly echogenic reflector with posterior acoustic shadowing in the gallbladder fossa, due to the presence of intraluminal and wall gas.

     
    Area of Interest: Abdomen; Imaging Technique: Ultrasound; Procedure: Diagnostic procedure; Special Focus: Ischaemia / Infarction;

    Note a small hepatic haemangioma in SV, near the gallbladder fossa.

     
    Area of Interest: Abdomen; Imaging Technique: Ultrasound; Procedure: Diagnostic procedure; Special Focus: Haemangioma;
     
     
  • Figure 3
    Non-enhanced CT of the abdomen and pelvis

    Presence of a large air-fluid level within the gallbladder lumen with sludge (the mean density of the bile was about 28UH), air along the entire wall and some small gallstones.

     
    Area of Interest: Abdomen; Imaging Technique: CT; Procedure: Diagnostic procedure; Special Focus: Infection;
     
     
  • Figure 4
    Post-contrast CT
     

    Acquisition during the arterial phase: the entire gallbladder wall was thickened and filled with air.

     
    Area of Interest: Abdomen; Imaging Technique: CT; Procedure: Diagnostic procedure; Special Focus: Ischaemia / Infarction;

    Acquisition during the portal venous phase: no significant wall enhancement was demonstrated, a condition strongly suggestive for ischaemia.

     
    Area of Interest: Abdomen; Imaging Technique: CT; Procedure: Diagnostic procedure; Special Focus: Ischaemia / Infarction;

    Acquisition during the portal venous phase: coronal view of the gallbladder wall and lumen.

     
    Area of Interest: Abdomen; Imaging Technique: CT; Procedure: Diagnostic procedure; Special Focus: Ischaemia / Infarction;
     
     
  • Figure 5
    Axial portal venous CT

    Presence of pericholecystic fat-stranding, pericholecystic and perihepatic fluid.

     
    Area of Interest: Abdomen; Imaging Technique: CT; Procedure: Diagnostic procedure; Special Focus: Inflammation;
     
     
  • Figure 6
    Portal venous CT
     

    Direct signs of pneumoperitoneum secondary to gallbladder perforation: free air in the right subdiaphragmatic space.

     
    Area of Interest: Abdomen; Imaging Technique: CT; Procedure: Diagnostic procedure; Special Focus: Ischaemia / Infarction;

    Direct signs of pneumoperitoneum secondary to gallbladder perforation: free air at the hepatic hilum.

     
    Area of Interest: Abdomen; Imaging Technique: CT; Procedure: Diagnostic procedure; Special Focus: Ischaemia / Infarction;

    Direct signs of pneumoperitoneum secondary to gallbladder perforation: free air also into the right anterior subhepatic space.

     
    Area of Interest: Abdomen; Imaging Technique: CT; Procedure: Diagnostic procedure; Special Focus: Ischaemia / Infarction;
     
     
  • Figure 7
    Axial post-contrast CT
     

    Free fluid was present among small bowel loops.

     
    Area of Interest: Abdomen; Imaging Technique: CT; Procedure: Diagnostic procedure; Special Focus: Inflammation;

    Free fluid was present in the right paracolic gutter.

     
    Area of Interest: Abdomen; Imaging Technique: CT; Procedure: Diagnostic procedure; Special Focus: Inflammation;

    Free fluid was present in the Douglas pouch.

     
    Area of Interest: Abdomen; Imaging Technique: CT; Procedure: Diagnostic procedure; Special Focus: Inflammation;
     
     
Note the oval finding with an air-fluid level inside and a thin peripheral rim of radiolucency in the right upper abdominal quadrant.
 
Highly echogenic reflector with posterior acoustic shadowing in the gallbladder fossa, due to the presence of intraluminal and wall gas.
 
Note a small hepatic haemangioma in SV, near the gallbladder fossa.
 
Presence of a large air-fluid level within the gallbladder lumen with sludge (the mean density of the bile was about 28UH), air along the entire wall and some small gallstones.
 
Acquisition during the arterial phase: the entire gallbladder wall was thickened and filled with air.
 
Acquisition during the portal venous phase: no significant wall enhancement was demonstrated, a condition strongly suggestive for ischaemia.
 
Acquisition during the portal venous phase: coronal view of the gallbladder wall and lumen.
 
Presence of pericholecystic fat-stranding, pericholecystic and perihepatic fluid.
 
Direct signs of pneumoperitoneum secondary to gallbladder perforation: free air in the right subdiaphragmatic space.
 
Direct signs of pneumoperitoneum secondary to gallbladder perforation: free air at the hepatic hilum.
 
Direct signs of pneumoperitoneum secondary to gallbladder perforation: free air also into the right anterior subhepatic space.
 
Free fluid was present among small bowel loops.
 
Free fluid was present in the right paracolic gutter.
 
Free fluid was present in the Douglas pouch.
 
 
 
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