Case 111: Empyema Gallbladder || Ultrasound

           

Clinical Features:

A 42-year-old male came with

- Severe right upper abdominal pain

- Vomiting

- Positive Murphy’s sign

Ultrasound Features:

- Distended gallbladder with thickened & edematous wall with peri-cholecystic mild collection.

- Gallbladder lumen shows hypoechoic sludge. Within the sludge, tiny echogenic structures are also seen without posterior acoustic shadow. Rest of the lumen contains low-level echoes showing acoustic streaming.

- Mild hepatosplenomegaly.

Remember:

Acoustic streaming can help differentiate pus from sludge in empyema.

Ultrasound Diagnosis:

Acute cholecystitis with biliary sludge, microcalculi/soft calculi & features of empyema.

Ultrasound Images:

Mild hepatomegaly

Mild splenomegaly

Thick GB wall

Acute cholecystitis with biliary sludge, microcalculi/soft calculi & features of empyema.

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