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July 2015

There is an abnormal echogenic anterior wall of the gallbladder is this air or calcium?
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Clinical information

Very sick patient with pain in the right upper abdomen and raised infection parameters

Ultrasound Images & Clips

Abnormal gallbladder

There is an abnormal echogenic anterior wall of the gallbladder is this air or calcium?
There is an abnormal echogenic anterior wall of the gallbladder is this air or calcium?
The echogenic wall causes artefacts seen with air
The echogenic wall causes artefacts seen with air
Transverse image
Transverse image
There are also some stones
There are also some stones
If it is air this is probably an emphysematous cholecystitis. Always look for a perforation. Patients with an emphysematous cholecystitis have a high risk of getting a perforation
If it is air this is probably an emphysematous cholecystitis. Always look for a perforation. Patients with an emphysematous cholecystitis have a high risk of getting a perforation
Another image showing some fluid around the gallbladder and a gallbladderwall defect and possibly some airbubbles outside the gallbladder
Another image showing some fluid around the gallbladder and a gallbladderwall defect and possibly some airbubbles outside the gallbladder
Detail of the stones and sludge in the gallbladder There is also a small defect in the gallbladderwall
Detail of the stones and sludge in the gallbladder There is also a small defect in the gallbladderwall
This is a CT scan of another female patient who is 70 years old who has abdominal pain and air in the gallbladder. The gallbladder is completely filled with air. Is this also an emphysematous cholecystitis?
This is a CT scan of another female patient who is 70 years old who has abdominal pain and air in the gallbladder. The gallbladder is completely filled with air. Is this also an emphysematous cholecystitis?
This is a CT image showing air in the intrahepatic bile ducts
This is a CT image showing air in the intrahepatic bile ducts
This CT scan shows air in the common bile duct
This CT scan shows air in the common bile duct
This is an image of her gallbladder a year before. She had not been operated and did not have an ERCP
This is an image of her gallbladder a year before. She had not been operated and did not have an ERCP
There is a large stone measuring more than 5,5cm. and thickened bile in the gallbladder
There is a large stone measuring more than 5,5cm. and thickened bile in the gallbladder
Transverse image of the gallbladder
Transverse image of the gallbladder
This is again a CT image taken at a lower level showing dilatated small bowel loops
This is again a CT image taken at a lower level showing dilatated small bowel loops
This is a CT image of the dilatated small bowel and the obstructing gallstone, which had perforated to the digestive tract and because of its size had caused a bowel obstruction.
This is a CT image of the dilatated small bowel and the obstructing gallstone, which had perforated to the digestive tract and because of its size had caused a bowel obstruction.
CT
CT
CT

Conclusion

Air in the gallbladder can have several reasons. The first patient had an emphysematous cholecystitis. A percutaneous drainage procedure was performed by us and the patient recovered well.
The second patient had a gallstone perforation to the digestive tract with bowel obstruction, and was operated by the surgeon.
Beware of another common reason of air in the gallbladder and bile ducts namely an ERCP and papillotomy.

Details

  • Sex: Female
  • Age: 86

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photo Taco Geertsma
Author

Dr. Taco Geertsma

Retired Radiologist, Gelderse Vallei Hospital

Dr. Taco Geertsma is the founder of UltrasoundCases.info and a retired radiologist and has worked in the Gelderse Vallei hospital from January 1, 1983. till July 1, 2014. He was the head of the ultrasound department for many years.

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