Emphysematous cholecystitis: sonographic findings

Abstract

Our series showed some characteristic US patterns of EC. A good understanding of its US findings and appropriate emergent management will reduce the serious morbidity and mortality rates caused by EC.

Unusual Presentation of a Gangrenous Cholecystitis that Mimics a Bowel Perforation

“…Anaerobic organisms grow easily in gallbladder with vascular insufficiency of the wall and alkaline bile, as occurs in cholecystitis. The excessive distension of the gallbladder wall can result into a leakage of gas through the intact mucosa, with the gas spreading into the perimuscular layers and collecting under the serosa and into the peritoneal cavity [8]. Gangrenous cholecystitis is a life-threatening condition, which can require one-or two-step early surgical intervention [9].…”

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

“…Affected patients are usually middle-aged to elderly individuals (age between 50-70 years). Common risk factors include patients with diabetes mellitus and presence of gallstones [1,4]. Its pathogenesis is considered to be different from that of uncomplicated acute cholecystitis.…”

“…Ultrasonography is considered to be the initial test of choice for the diagnosis of hepatobiliary pathology. 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. In this case, computed tomography is very helpful and becomes a diagnostic modality of choice for complicated cholecystitis [4][5][6]. Surgical therapy is always the mainstay of management of emphysematous cholecystitis with adjunctive antimicrobial treatment.…”

“…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].…”