UMEM Educational Pearls

Category: Visual Diagnosis

Title: What's the Diagnosis? Case by Dr. Ryan Spangler

Posted: 9/29/2013 by Haney Mallemat, MD (Emailed: 9/30/2013) (Updated: 9/30/2013)
Click here to contact Haney Mallemat, MD

Question

65 year-old diabetic patient presents with abdominal pain. What's the abnormality on Xray?

 

Answer

Emphysematous Cholecystitis

Emphysematous Cholecystitis

  • More common in elderly patients, especially with diabetes
  • Usually due to ischemia secondary to systemic hypoperfusion, atherosclerosis, embolism, or vasculitis
  • Common organisms causing infection include Clostridium, E. Coli, Klebsiella, and anaerobic streptococci.
  • Early antibiotic treatment is mandatory, but definitive surgery is typically required
  • Air-fluid level and distended gallbladder may be seen on upright plain abdominal radiographs; CT scan demonstrates air in the GB wall and sometimes throughout the biliary tree

References

Carrascosa MF, et al.  Emphysematous Cholecystitis. CMAJ.10 Jan 2012; 184(1): E81

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