Emphysematous Cholecystitis

Abstract

A 75-year-old male patient with a history of diabetes mellitus and coronary artery disease status post coronary artery bypass graft presents with a 3-day history of right upper and lower quadrant pain.

Early Sonographic Diagnosis of Emphysematous Cholecystitis Successfully Treated With Antibiotics

“…7,8 Sonography is less sensitive but highly specific for identifying air in the gallbladder and can be used to diagnose EC early and accurately. 9,10 When there is air present in the gallbladder wall or lumen, echogenic foci with posterior dirty shadowing, or reverberation artifact, emanate from the gallbladder wall or lumen. While sonography can be accurately used to evaluate patients with EC, CT is the most specific imaging modality for the diagnosis of EC.…”

“…In addition, EC will demonstrate dirty shadowing due to the presence of air, whereas porcelain gallbladder will have a clean shadow due to the presence of calcifications. 10,14 Porcelain gallbladder was previously thought to be a premalignant process, but recent large studies show that the risk for gallbladder carcinoma is approximately 5% to 7%. 15 Currently, no data are available to indicate the value of follow-up or new incidence, but it is estimated to be less than 1%, and current recommendations do not support follow-up in patients with porcelain gallbladder.…”

Imaging of Abnormal Air in the Abdomen and Pelvis

“…Emphysematous cholecystitis must be promptly diagnosed by the radiologist as the air present can dissect into portal veins secondary to ischemia of gallbladder wall. 19…”

Necrotizing Fasciitis Secondary to Emphysematous Cholecystitis and Cholecystocutaneous Fistula: A Rare Case Report Presentation

“…The mortality rate of acute emphysematous cholecystitis is 15% -20% compared with 1.4% in uncomplicated acute cholecystitis [1]. Risk factors include male sex, peripheral atherosclerotic disease, and diabetes mellitus [2].…”

“…and Escherichia coli[1] [2]. Presenting signs and symptoms include right upper quadrant abdominal pain with or without Murphy's sign (inspiratory arrest upon right upper quadrant palpation), low-grade fever, nausea, and emesis.…”