January 25, 2009

Emphysematous Cholecystitis

Fig. 1: Transverse ultrasound image (with color flow) of an 82-year-old woman with RUQ pain shows thickening of the gallbladder wall (two-head arrow), distended gallbladder, and multiple hyperechoic dots with posterior reverberation artifacts (or 'ring-down' artifacts).
Fig. 2: Coronal-reformatted CT image performed subsequently reveals gas (arrow) in the gallbladder lumen, marked thickening of the gallbladder wall (double-head arrow), distention of gallbladder, enhancement of gallbladder wall (arrowheads). Conglomerate mass in the gallbladder wall represents sludge. Findings are consistent with emphysematous cholecystitis.


  • Gas in gallbladder wall or lumen
  • Clinical setting of acute cholecystitis
  • No evidence of fistula between gallbladder and bowel
  • Common organisms are Clostridium, E. coli, S. aureus and Streptococcus.
  • May be seen on radiography as curvilinear lucency or air-fluid level in RUQ
  • Gas on ultrasound appears as hyperechoic dots/line with posterior reverberation artifact
  • CT is the most specific and sensitive method to diagnose this condition.

Smith EA, et al. Cross-sectional imaging of acute and chronic gallbladder inflammatory disease.
AJR 2009; 192:188-196

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