Ultrasonic demonstration of an intraluminal pseudomembrane in the gallbladder: A definitive sign of acute cholecystitis?

Abstract

The sonographic features of acute cholecystitis are well do~umented,'-~ but none of these are considered pathognomonic of this Pathologically, ulceration and sloughing of the mucosa occurs in severe inflammation of the gallbladder and this is responsible for the indistinctness of the luminal wall demonstrated sonographically. lo Recently, there have been two reports of intraluminal membranous septa in the gallbladder of patients who were subsequently shown to have acute cholecystitis.113'2 We report a case of acute cholecystitis with intraluminal membranous septa and suggest that this should be considered as a specific sign of acute cholecystitis in the presence of indistinctness of the gallbladder wall. CASE REPORTA 27-year-old woman was admitted with a 14hour history of severe colicky epigstric pain radiating around the sides to the back. Examination revealed tenderness and guarding in the epigastrium.Laboratory investigations revealed a leucocytosis of 18.0 white blood cells per liter, a normal serum amylase level, and normal electrolytes and liver function tests.Ultrasound examination was performed a day later. Several stone-like echoes were seen in the gallbladder. There was a multiseptate appearance of fine nonshadowing strands in the lumen of the gallbladder. In addition, a circumferential irregular membrane was seen separating from From the