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Cholecystitis, Acute: Multimedia

Author: Ali Nawaz Khan, MBBS, FRCS, FRCP, FRCR, LRCP, Chairman of Medical Imaging, Professor of Radiology, NGHA, King Fahad National Guard Hospital, King Abdulaziz Medical City, Riyadh, Saudi Arabia
Coauthor(s): Sumaira MacDonald, MBChB, PhD, MRCP, FRCR, Lecturer, Sheffield University Medical School; Endovascular Fellow, Sheffield Vascular Institute; Tufail Ahmed Patankar, MBBS, FRCR, PhD, DMRD, DMRE, DNBE, Consulting Neuroradiologist and Interventional Neuroradiologist, Department of Neuroradiology, Royal Preston Hospital, Lancashire Teaching Hospitals NHS Foundation Trust; Lalam Radhesh Krishna, MBBS, MRCS, Specialist Registrar, Department of Radiology, North Manchester General Hospital; Hemalatha Chandramohan, MBBS, Staff Physician, Department of Geriatric Medicine, Stepping Hill Hospital, United Kingdom; David Sherlock, MBBS, FRCS, Consulting Staff, Department of Surgery, North Manchester General Hospital, Christie Hospital; Ravi Devidas Kadasne, MBBS, MD, Specialist in Radiology, Emirates International Hospital, UAE
Contributor Information and Disclosures

Updated: Feb 4, 2009

Multimedia

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Media file 1: Plain abdominal radiograph of a 68-year-old woman who presented with acute abdominal pain. There are multiple calculi distributed in a pyriform shape in the right upper quadrant; these are suggestive of gallstones. Gallstones were diagnosed during sonography several months earlier. A clinical diagnosis of acute cholecystitis was made. However, the plain radiograph also shows features of a pneumoperitoneum. At laparotomy, a perforated cecal carcinoma was found. There were no findings of acute cholecystitis.

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Plain abdominal radiograph of a 68-year-old woman who presented with acute abdominal pain. There are multiple calculi distributed in a pyriform shape in the right upper quadrant; these are suggestive of gallstones. Gallstones were diagnosed during sonography several months earlier. A clinical diagnosis of acute cholecystitis was made. However, the plain radiograph also shows features of a pneumoperitoneum. At laparotomy, a perforated cecal carcinoma was found. There were no findings of acute cholecystitis.

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Media file 2: (Left) Plain radiograph of a 57-year-old woman presenting with right iliac fossa pain and mild fever shows large laminated opacities in the right iliac fossa (RIF); these findings suggest gallstones (arrow). Two smaller nonlaminated oval opacities are present more medially; these were interpreted as calculi in the cystic duct. Ultrasonography revealed a Reidel lobe of the liver. The gallbladder was located in the RIF and contained several calculi; however, no ultrasonographic features of acute cholecystitis were observed. The right kidney was also placed in the RIF, in a more medial location. Two calculi were present—one each in the upper and lower pole calices. (Right) Intravenous urogram shows a low-lying right kidney with calculi in the upper and lower pole calices. Urine culture revealed Escherichia coli. The patient's condition responded to a course of antibiotics. This example shows that an acute pyelonephritis can clinically mimic acute cholecystitis. With a Reidel lobe, the gallbladder may be located in the RIF, and an acute cholecystitis may mimic appendicitis or other RIF pathology.

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(Left) Plain radiograph of a 57-year-old woman presenting with right iliac fossa pain and mild fever shows large laminated opacities in the right iliac fossa (RIF); these findings suggest gallstones (arrow). Two smaller nonlaminated oval opacities are present more medially; these were interpreted as calculi in the cystic duct. Ultrasonography revealed a Reidel lobe of the liver. The gallbladder was located in the RIF and contained several calculi; however, no ultrasonographic features of acute cholecystitis were observed. The right kidney was also placed in the RIF, in a more medial location. Two calculi were present—one each in the upper and lower pole calices. (Right) Intravenous urogram shows a low-lying right kidney with calculi in the upper and lower pole calices. Urine culture revealed Escherichia coli. The patient's condition responded to a course of antibiotics. This example shows that an acute pyelonephritis can clinically mimic acute cholecystitis. With a Reidel lobe, the gallbladder may be located in the RIF, and an acute cholecystitis may mimic appendicitis or other RIF pathology.

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Media file 3: Plain abdominal radiograph in a 49-year-old diabetic woman shows air within the gallbladder lumen due to emphysematous cholecystitis (arrow).

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Plain abdominal radiograph in a 49-year-old diabetic woman shows air within the gallbladder lumen due to emphysematous cholecystitis (arrow).

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Media file 4: Plain abdominal radiograph in a patient with a clinical diagnosis of acute cholecystitis. The diagnosis was confirmed by means of abdominal ultrasonography. The radiograph shows faint opacities in the region of the gallbladder fossa and dilated loops of small bowel in the epigastrium and mid abdomen secondary to localized ileus.

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Plain abdominal radiograph in a patient with a clinical diagnosis of acute cholecystitis. The diagnosis was confirmed by means of abdominal ultrasonography. The radiograph shows faint opacities in the region of the gallbladder fossa and dilated loops of small bowel in the epigastrium and mid abdomen secondary to localized ileus.

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Media file 5: This patient presented with acute cholecystitis, as confirmed at imaging. His pain resolved over a few days, but mildly elevated bilirubin levels persisted. Endoscopic retrograde cholangiopancreatographic (ERCP) study shows smooth narrowing of the bile duct (arrow) at the site of insertion of the cystic duct (Mirizzi syndrome). Note the small calculus in the cystic duct.

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This patient presented with acute cholecystitis, as confirmed at imaging. His pain resolved over a few days, but mildly elevated bilirubin levels persisted. Endoscopic retrograde cholangiopancreatographic (ERCP) study shows smooth narrowing of the bile duct (arrow) at the site of insertion of the cystic duct (Mirizzi syndrome). Note the small calculus in the cystic duct.

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Media file 6: Longitudinal oblique sonogram through the gallbladder shows a calculus at the neck of the gallbladder with acoustic shadowing and thickening of the gallbladder wall (arrow).

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Longitudinal oblique sonogram through the gallbladder shows a calculus at the neck of the gallbladder with acoustic shadowing and thickening of the gallbladder wall (arrow).

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Media file 7: Longitudinal and axial scans through the gallbladder show layering of sludge (S) in the gallbladder lumen.

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Longitudinal and axial scans through the gallbladder show layering of sludge (S) in the gallbladder lumen.

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Media file 8: Oblique and longitudinal sonograms through gallbladder shows marked laminated sonolucent thickening of the gallbladder wall, sludge, and edema (arrow).

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Oblique and longitudinal sonograms through gallbladder shows marked laminated sonolucent thickening of the gallbladder wall, sludge, and edema (arrow).

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Media file 9: Axial scan through the gallbladder shows marked thickening of the gallbladder wall, with the lumen of the gallbladder full of sludge.

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Axial scan through the gallbladder shows marked thickening of the gallbladder wall, with the lumen of the gallbladder full of sludge.

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Media file 10: This 26-year-old man known to be HIV positive presented with pain in the right upper quadrant and mild jaundice. Axial sonogram through the gallbladder and pancreas shows sludge within the gallbladder and the lower common bile duct (CBD). A diagnosis of acalculous cholecystitis was confirmed. Arrow indicates the CBD; A, aorta; GB, gallbladder; IVC, inferior vena cava; P, pancreas; and S, splenic vein.

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This 26-year-old man known to be HIV positive presented with pain in the right upper quadrant and mild jaundice. Axial sonogram through the gallbladder and pancreas shows sludge within the gallbladder and the lower common bile duct (CBD). A diagnosis of acalculous cholecystitis was confirmed. Arrow indicates the CBD; A, aorta; GB, gallbladder; IVC, inferior vena cava; P, pancreas; and S, splenic vein.

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Media file 11: Ultrasonogram of the gallbladder shows focal thickening of the gallbladder wall (arrow) that mimics a carcinoma.

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Ultrasonogram of the gallbladder shows focal thickening of the gallbladder wall (arrow) that mimics a carcinoma.

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Media file 12: Longitudinal oblique ultrasonogram through the gallbladder shows pseudomembrane formation due to sloughed mucosa. Note the small calculus.

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Longitudinal oblique ultrasonogram through the gallbladder shows pseudomembrane formation due to sloughed mucosa. Note the small calculus.

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Media file 13: Axial ultrasonogram through the gallbladder shows tiny calculi in the gallbladder and pericholecystic fluid.

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Axial ultrasonogram through the gallbladder shows tiny calculi in the gallbladder and pericholecystic fluid.

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Media file 14: Four scans of different orientations through the gallbladder shows gallbladder wall thickening, pseudomembrane formation, sludge, and pericholecystic fluid.

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Four scans of different orientations through the gallbladder shows gallbladder wall thickening, pseudomembrane formation, sludge, and pericholecystic fluid.

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Media file 15: Ultrasonogram shows complete disorganization of the gallbladder and its fossa that mimics a gallbladder carcinoma.

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Ultrasonogram shows complete disorganization of the gallbladder and its fossa that mimics a gallbladder carcinoma.

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Media file 16: Normal cholescintigrams. Normal technetium-99m hepatic iminodiacetic acid (^99mTc-HIDA) scans of the liver shows normal gallbladder filling within 45 minutes.

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Normal cholescintigrams. Normal technetium-99m hepatic iminodiacetic acid (^99mTc-HIDA) scans of the liver shows normal gallbladder filling within 45 minutes.

Technetium-99m hepatic iminodiacetic acid (<SUP>9...

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Media file 17: Technetium-99m hepatic iminodiacetic acid (^99mTc-HIDA) scan followed for 1 hour 30 minutes shows no filling of the gallbladder due to cystic duct obstruction.

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Technetium-99m hepatic iminodiacetic acid (^99mTc-HIDA) scan followed for 1 hour 30 minutes shows no filling of the gallbladder due to cystic duct obstruction.

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Media file 18: Nonenhanced CT scans through the gallbladder (GB) shows an indistinct GB wall. Contrast-enhanced CT scan (bottom) shows an inflammatory reaction in the pericholecystic fat, which is seen as streaky or bandlike soft-tissue areas of attenuation extending from the GB wall into the surrounding fat. Note the loss of the interface between the GB and surrounding soft tissue on both the nonenhanced (top) and enhanced (bottom) scans. Note also the striking enhancement of GB and pericholecystic tissues following the use of intravenous contrast material.

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Nonenhanced CT scans through the gallbladder (GB) shows an indistinct GB wall. Contrast-enhanced CT scan (bottom) shows an inflammatory reaction in the pericholecystic fat, which is seen as streaky or bandlike soft-tissue areas of attenuation extending from the GB wall into the surrounding fat. Note the loss of the interface between the GB and surrounding soft tissue on both the nonenhanced (top) and enhanced (bottom) scans. Note also the striking enhancement of GB and pericholecystic tissues following the use of intravenous contrast material.

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Media file 19: Acute emphysematous cholecystitis. Color Doppler images of the gallbladder of an 82-year-old male with diabetes mellitus who presented with abdominal distention and vomiting. Ultrasound shows a markedly thickened gallbladder wall, which is hypervascularized. There are no gallstones, but note the presence of air in the anterior wall of the gallbladder (arrow).

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Acute emphysematous cholecystitis. Color Doppler images of the gallbladder of an 82-year-old male with diabetes mellitus who presented with abdominal distention and vomiting. Ultrasound shows a markedly thickened gallbladder wall, which is hypervascularized. There are no gallstones, but note the presence of air in the anterior wall of the gallbladder (arrow).

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Media file 20: Acute cholecystitis mimic. Series of ultrasound and CT images (Images 20-24) are shown of a 36-year-old woman with severe right hypochondriacal pain. The gallbladder wall is thickened, with a suggestion of the triple wall sign. There is a streak of pericholecystic fluid at the inferior aspect of the gallbladder. An ultrasound for the Murphy sign was negative. No gallstones were seen. There were no predisposing causes of an acalculous acute cholecystitis. A supine CT showed signs of inflammation in the region of the duodenum, but the duodenal wall was not well seen. However, further CT sections in the right decubitus position showed spasm and thickening of the wall of the first part of the duodenum. Endoscopy revealed an acute penetrating duodenal ulcer.

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Acute cholecystitis mimic. Series of ultrasound and CT images (Images 20-24) are shown of a 36-year-old woman with severe right hypochondriacal pain. The gallbladder wall is thickened, with a suggestion of the triple wall sign. There is a streak of pericholecystic fluid at the inferior aspect of the gallbladder. An ultrasound for the Murphy sign was negative. No gallstones were seen. There were no predisposing causes of an acalculous acute cholecystitis. A supine CT showed signs of inflammation in the region of the duodenum, but the duodenal wall was not well seen. However, further CT sections in the right decubitus position showed spasm and thickening of the wall of the first part of the duodenum. Endoscopy revealed an acute penetrating duodenal ulcer.

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Media file 21: Acute cholecystitis mimic. Series of ultrasound and CT images are shown of a 36-year-old woman with severe right hypochondriacal pain. The gallbladder wall is thickened, with a suggestion of the triple wall sign. There is a streak of pericholecystic fluid at the inferior aspect of the gallbladder. An ultrasound of the Murphy sign was negative. No gallstones were seen. There were no predisposing causes of an acalculous acute cholecystitis. A supine CT showed signs of inflammation in the region of the duodenum, but the duodenal wall was not well seen. However further CT sections in the right decubitus position showed spasm and thickening of the wall of the first part of the duodenum. Endoscopy revealed an acute penetrating duodenal ulcer.

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Acute cholecystitis mimic. Series of ultrasound and CT images are shown of a 36-year-old woman with severe right hypochondriacal pain. The gallbladder wall is thickened, with a suggestion of the triple wall sign. There is a streak of pericholecystic fluid at the inferior aspect of the gallbladder. An ultrasound of the Murphy sign was negative. No gallstones were seen. There were no predisposing causes of an acalculous acute cholecystitis. A supine CT showed signs of inflammation in the region of the duodenum, but the duodenal wall was not well seen. However further CT sections in the right decubitus position showed spasm and thickening of the wall of the first part of the duodenum. Endoscopy revealed an acute penetrating duodenal ulcer.

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Media file 22: Acute cholecystitis mimic. Series of ultrasound and CT images are shown of a 36-year-old woman with severe right hypochondriacal pain. The gallbladder wall is thickened, with a suggestion of the triple wall sign. There is streak of pericholecystic fluid at the inferior aspect of the gallbladder. An ultrasound of the Murphy sign was negative. No gallstones were seen. There were no predisposing causes of an acalculous acute cholecystitis. A supine CT showed signs of inflammation in the region of the duodenum, but the duodenal wall was not well seen. However, further CT sections in the right decubitus position showed spasm and thickening of the wall of the first part of the duodenum. Endoscopy revealed an acute penetrating duodenal ulcer.

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Acute cholecystitis mimic. Series of ultrasound and CT images are shown of a 36-year-old woman with severe right hypochondriacal pain. The gallbladder wall is thickened, with a suggestion of the triple wall sign. There is streak of pericholecystic fluid at the inferior aspect of the gallbladder. An ultrasound of the Murphy sign was negative. No gallstones were seen. There were no predisposing causes of an acalculous acute cholecystitis. A supine CT showed signs of inflammation in the region of the duodenum, but the duodenal wall was not well seen. However, further CT sections in the right decubitus position showed spasm and thickening of the wall of the first part of the duodenum. Endoscopy revealed an acute penetrating duodenal ulcer.

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Media file 23: Acute cholecystitis mimic. Series of ultrasound and CT images are shown of a 36-year-old woman with severe right hypochondriacal pain. The gallbladder wall is thickened with a suggestion of the triple wall sign. There is a streak of pericholecystic fluid at the inferior aspect of the gallbladder. An ultrasound of the Murphy sign was negative. No gallstones were seen. There were no predisposing causes of an acalculous acute cholecystitis. A supine CT showed signs of inflammation in the region of the duodenum, but the duodenal wall was not well seen. However, further CT sections in the right decubitus position showed spasm and thickening of the wall of the first part of the duodenum. Endoscopy revealed an acute penetrating duodenal ulcer.

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Acute cholecystitis mimic. Series of ultrasound and CT images are shown of a 36-year-old woman with severe right hypochondriacal pain. The gallbladder wall is thickened with a suggestion of the triple wall sign. There is a streak of pericholecystic fluid at the inferior aspect of the gallbladder. An ultrasound of the Murphy sign was negative. No gallstones were seen. There were no predisposing causes of an acalculous acute cholecystitis. A supine CT showed signs of inflammation in the region of the duodenum, but the duodenal wall was not well seen. However, further CT sections in the right decubitus position showed spasm and thickening of the wall of the first part of the duodenum. Endoscopy revealed an acute penetrating duodenal ulcer.

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Media file 24: Acute cholecystitis mimic. Series of ultrasound and CT images are shown of a 36-year-old woman with severe right hypochondriacal pain. The gallbladder wall is thickened, with a suggestion of the triple wall sign. There is a streak of pericholecystic fluid at the inferior aspect of the gallbladder. An ultrasound of the Murphy sign was negative. No gallstones were seen. There were no predisposing causes of an acalculous acute cholecystitis. A supine CT showed signs of inflammation in the region of the duodenum, but the duodenal wall was not well seen. However, further CT sections in the right decubitus position showed spasm and thickening of the wall of the first part of the duodenum. Endoscopy revealed an acute penetrating duodenal ulcer.

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Acute cholecystitis mimic. Series of ultrasound and CT images are shown of a 36-year-old woman with severe right hypochondriacal pain. The gallbladder wall is thickened, with a suggestion of the triple wall sign. There is a streak of pericholecystic fluid at the inferior aspect of the gallbladder. An ultrasound of the Murphy sign was negative. No gallstones were seen. There were no predisposing causes of an acalculous acute cholecystitis. A supine CT showed signs of inflammation in the region of the duodenum, but the duodenal wall was not well seen. However, further CT sections in the right decubitus position showed spasm and thickening of the wall of the first part of the duodenum. Endoscopy revealed an acute penetrating duodenal ulcer.

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Media file 25: Acute cholecystitis mimic. Ultrasound image of the gallbladder of a patient with acute lymphatic leukemia, showing marked gallbladder wall thickening with no clinical features of acute or chronic cholecystitis.

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Acute cholecystitis mimic. Ultrasound image of the gallbladder of a patient with acute lymphatic leukemia, showing marked gallbladder wall thickening with no clinical features of acute or chronic cholecystitis.

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Media file 26: CT scan shows pearl gallstones and thickening of the gallbladder wall.

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CT scan shows pearl gallstones and thickening of the gallbladder wall.

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Media file 27: Line diagrams show a trocar method of cholecystostomy and placement of a pigtail catheter in the gallbladder lumen.

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Line diagrams show a trocar method of cholecystostomy and placement of a pigtail catheter in the gallbladder lumen.

More on Cholecystitis, Acute

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Imaging: Cholecystitis, Acute

Follow-up: Cholecystitis, Acute

Multimedia: Cholecystitis, Acute

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Keywords

acute cholecystitis, acute acalculous cholecystitis, acalculous cholecystitis, AC, AAC, necrotizing cholecystitis, emphysematous cholecystitis

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Contributor Information and Disclosures

Author

Ali Nawaz Khan, MBBS, FRCS, FRCP, FRCR, LRCP, Chairman of Medical Imaging, Professor of Radiology, NGHA, King Fahad National Guard Hospital, King Abdulaziz Medical City, Riyadh, Saudi Arabia
Ali Nawaz Khan, MBBS, FRCS, FRCP, FRCR, LRCP is a member of the following medical societies: American Institute of Ultrasound in Medicine, Radiological Society of North America, Royal College of Physicians, Royal College of Physicians and Surgeons of the United States, Royal College of Radiologists, and Royal College of Surgeons of England
Disclosure: Nothing to disclose.

Coauthor(s)

Sumaira MacDonald, MBChB, PhD, MRCP, FRCR, Lecturer, Sheffield University Medical School; Endovascular Fellow, Sheffield Vascular Institute
Sumaira MacDonald, MBChB, PhD, MRCP, FRCR is a member of the following medical societies: British Medical Association, Royal College of Physicians, and Royal College of Radiologists
Disclosure: Nothing to disclose.

Tufail Ahmed Patankar, MBBS, FRCR, PhD, DMRD, DMRE, DNBE, Consulting Neuroradiologist and Interventional Neuroradiologist, Department of Neuroradiology, Royal Preston Hospital, Lancashire Teaching Hospitals NHS Foundation Trust
Tufail Ahmed Patankar, MBBS, FRCR, PhD, DMRD, DMRE, DNBE is a member of the following medical societies: British Society of Neuroradiologists and Royal College of Radiologists
Disclosure: Nothing to disclose.

Lalam Radhesh Krishna, MBBS, MRCS, Specialist Registrar, Department of Radiology, North Manchester General Hospital
Disclosure: Nothing to disclose.

Hemalatha Chandramohan, MBBS, Staff Physician, Department of Geriatric Medicine, Stepping Hill Hospital, United Kingdom
Disclosure: Nothing to disclose.

David Sherlock, MBBS, FRCS, Consulting Staff, Department of Surgery, North Manchester General Hospital, Christie Hospital
Disclosure: Nothing to disclose.

Ravi Devidas Kadasne, MBBS, MD, Specialist in Radiology, Emirates International Hospital, UAE
Disclosure: Nothing to disclose.

Medical Editor

John L Haddad, MD, Clinical Associate Professor, Department of Radiology, Weill Medical College of Cornell University; Director of Body MRI, Department of Radiology, Methodist Hospital in Houston
John L Haddad, MD is a member of the following medical societies: American College of Radiology, American Medical Association, and Radiological Society of North America
Disclosure: Nothing to disclose.

Pharmacy Editor

Bernard D Coombs, MB, ChB, PhD, Consulting Staff, Department of Specialist Rehabilitation Services, Hutt Valley District Health Board, New Zealand
Disclosure: Nothing to disclose.

Managing Editor

Arnold C Friedman, MD, FACR, Associate Chairman, Department of Radiology, University of Florida Health Science Center; Chief, Department of Radiology, Shands-Jacksonville Hospital
Arnold C Friedman, MD, FACR is a member of the following medical societies: American College of Radiology, American Institute of Ultrasound in Medicine, American Roentgen Ray Society, Association of University Radiologists, and Radiological Society of North America
Disclosure: Nothing to disclose.

CME Editor

Robert M Krasny, MD, Consulting Staff, Department of Radiology, The Angeles Clinic and Research Institute
Robert M Krasny, MD is a member of the following medical societies: American Roentgen Ray Society and Radiological Society of North America
Disclosure: Nothing to disclose.

Chief Editor

John Karani, MBBS, FRCR, Consulting Staff, Department of Radiology, King's College Hospital, London
Disclosure: Nothing to disclose.

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eMedicine Specialties > Radiology > Gastrointestinal

Cholecystitis, Acute: Multimedia

Multimedia

Plain abdominal radiograph in a 49-year-old diabetic woman shows air within the gallbladder lumen due to emphysematous cholecystitis (arrow).

Longitudinal oblique sonogram through the gallbladder shows a calculus at the neck of the gallbladder with acoustic shadowing and thickening of the gallbladder wall (arrow).

Longitudinal and axial scans through the gallbladder show layering of sludge (S) in the gallbladder lumen.

Oblique and longitudinal sonograms through gallbladder shows marked laminated sonolucent thickening of the gallbladder wall, sludge, and edema (arrow).

Axial scan through the gallbladder shows marked thickening of the gallbladder wall, with the lumen of the gallbladder full of sludge.

Ultrasonogram of the gallbladder shows focal thickening of the gallbladder wall (arrow) that mimics a carcinoma.

Longitudinal oblique ultrasonogram through the gallbladder shows pseudomembrane formation due to sloughed mucosa. Note the small calculus.

Axial ultrasonogram through the gallbladder shows tiny calculi in the gallbladder and pericholecystic fluid.

Four scans of different orientations through the gallbladder shows gallbladder wall thickening, pseudomembrane formation, sludge, and pericholecystic fluid.

Ultrasonogram shows complete disorganization of the gallbladder and its fossa that mimics a gallbladder carcinoma.

Normal cholescintigrams. Normal technetium-99m hepatic iminodiacetic acid (99mTc-HIDA) scans of the liver shows normal gallbladder filling within 45 minutes.

Technetium-99m hepatic iminodiacetic acid (99mTc-HIDA) scan followed for 1 hour 30 minutes shows no filling of the gallbladder due to cystic duct obstruction.

Acute cholecystitis mimic. Ultrasound image of the gallbladder of a patient with acute lymphatic leukemia, showing marked gallbladder wall thickening with no clinical features of acute or chronic cholecystitis.

CT scan shows pearl gallstones and thickening of the gallbladder wall.

Line diagrams show a trocar method of cholecystostomy and placement of a pigtail catheter in the gallbladder lumen.

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Normal cholescintigrams. Normal technetium-99m hepatic iminodiacetic acid (^99mTc-HIDA) scans of the liver shows normal gallbladder filling within 45 minutes.

Technetium-99m hepatic iminodiacetic acid (^99mTc-HIDA) scan followed for 1 hour 30 minutes shows no filling of the gallbladder due to cystic duct obstruction.