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Cholecystitis, Acalculous: Multimedia
Updated: Oct 16, 2008
Multimedia
 | Media file 1: Abdominal radiograph of acalculous emphysematous cholecystitis demonstrating curvilinear air pattern conforming to the shape of the gallbladder wall. |
 | Media file 2: CT images of emphysematous cholecystitis (same patient as Image 1). |
 | Media file 3: CT cine loop of acalculous cholecystitis demonstrates irregular gallbladder wall, pericholecystic inflammation, and perihepatitis in gallbladder fossa. Necrotic gallbladder was present at surgery. |
 | Media file 4: Normal hepato-iminodiacetic acid scan. Prompt hepatic concentration of radiopharmaceutical is noted, along with early visualization of the gallbladder and drainage into the duodenum. |
 | Media file 5: Hepato-iminodiacetic acid scan of acalculous cholecystitis. Prompt uptake of radiopharmaceutical is noted in the liver, along with drainage into the bowel without gallbladder visualization by 90 minutes. |
 | Media file 6: Ultrasound of ICU patient with fever of unclear etiology. Ultrasound findings of acalculous cholecystitis include marked gallbladder wall thickening and pericholecystic fluid. Localized tenderness could not be evaluated. |
 | Media file 7: Transverse ultrasound demonstrates marked gallbladder wall thickening and pericholecystic fluid collection in a patient with AIDS who was managed conservatively. No localized tenderness was noted, and hepato-iminodiacetic acid scan demonstrated delayed filling but otherwise was normal. Patient recovered with treatment of underlying pneumonia, and ultrasound findings normalized within 2 weeks. |
 | Media file 8: A 53-year-old man status post–endoscopic stenting for pancreatic cancer with progressive fever, leukocytosis, and right upper quadrant pain. Ultrasound demonstrates gallbladder distention, biliary sludge, borderline wall thickness, and localized tenderness consistent with acalculous cholecystitis. |
 | Media file 9: Images from percutaneous transhepatic cholecystostomy tube placement using coaxial technique demonstrating transhepatic needle access, irregular gallbladder wall, and occluded cystic duct (same patient as Image 8). Note the safety wire adjacent to the definitive 6F drainage catheter. |
 | Media file 10: Despite drainage, the patient (same patient as Images 8 and 9) continued to experience right upper quadrant pain and leukocytosis. Ultrasound and CT studies demonstrate transhepatic cholecystomy catheter in good position, but interval development of markedly worsening gallbladder wall edema and pericholecystic inflammatory changes have occurred. At surgery, gangrenous gallbladder was found and resected successfully. |
 | Media file 11: Ultrasound images from percutaneous cholecystomy using the trocar technique. Ultrasound guides transhepatic access to the gallbladder with a 6F trocar drainage catheter. After access, the catheter is fed forward to reform the distal pigtail within the gallbladder lumen and is locked in this configuration. |
 | Media file 12: Cine image of pigtail catheter moving freely within the gallbladder, which confirms adequate placement, along with free return of bile from the catheter. |
 | Media file 13: Cine loop percutaneous cholecystostomy tractogram demonstrates immature tract 3 weeks after percutaneous cholecystostomy. Free spillage of contrast into the peritoneal space is noted. Drainage was continued for an additional 2 weeks prior to catheter removal. |
 | Media file 14: Cholecystogram 4 weeks status post–cholecystomy tube placement for acalculous cholecystitis demonstrating a patent cystic and common duct and the absence of calculi. All clinical signs and symptoms had resolved. |
More on Cholecystitis, Acalculous |
| Overview: Cholecystitis, Acalculous |
| Imaging: Cholecystitis, Acalculous |
| Follow-up: Cholecystitis, Acalculous |
 Multimedia: Cholecystitis, Acalculous |
| References |
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References
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Further Reading
Keywords
acalculous cholecystitis, gallbladder inflammation, acalculous gallbladder inflammation, cholecystitis, gallbladder disease, biliary tract disease, digestive system disease, necrotizing cholecystitis, acute acalculous cholecystitis
