The effervescent gallbladder: a sonographic sign of emphysematous cholecystitis

Sonographic Non-Visualization of the Gallbladder: A Pitfall in Diagnosis of Emphysematous Cholecystitis

“…Its pathogenesis is considered to be different from that of uncomplicated acute cholecystitis. Among others, the widely accepted pathogenic mechanism of emphysematous cholecystitis is thought to be compromise of vascular supply to the gallbladder, followed by gallbladder necrosis and secondary infection with gas-producing bacteria mainly Clostridium perfringens, often together with other gut flora such as Escherichia coli, Klebsiella pneumoniae, Pseudomonas aeruginosa, or anaerobic streptococci [1][2][3][4].…”

“…The various ultrasound features of emphysematous cholecystitis depend on the amount and location of gas within the lumen or wall of the gallbladder [4,5]. One of its sonographic characteristic findings is described as the "effervescent gallbladder" with floating multiple echogenic foci in the lumen of the gallbladder like champagne bubbles [2]. When a layer of the gas within the gallbladder wall is circled around the gallbladder, it usually obscures the visualization of gallbladder on the ultrasound, resulting in reporting of "non-visualized gallbladder", which could easily be disregarded by clinicians.…”

“…Although computed tomography is the imaging diagnosis of choice, ultrasound is almost always the first initial test ordered. Sonographic finding, highly suggestive of emphysematous cholecysitis, is known as the effervescent gallbladder in which multiple echogenic foci rising from the bottom to the top within the gallbladder resembling champagne gas bubbles [2].…”

Is it just another case of acute uncomplicated cholecystitis? A case of emphysematous cholecystitis an uncommon complication and associated image findings

“…This is known as the champagne sign and seen in (Figure 1). It is so called as it is thought to resemble the effervescent bubbles of champagne rising from a glass [1][2][3][4][5]. It is specific but insensitive for emphysematous cholecystitis and is also an uncommon finding.…”

Diseases of the Gallbladder and Bile Ducts

“…1). The latter appearance has been termed the "effervescent gallblad-der" because it resembles the appearance of effervescent bubbles rising in a champagne glass [4,5]. Careful attention to the appearance of suspected intramural and intraluminal gas should be made because other highly reflective entities such as calcification in the gallbladder wall, a contracted gallbladder with stones, or adenomyomatous hyperplasia may be mistaken for intramural or intraluminal gas.…”