- Written by Jakub Bartnik
A 88 year old female presents to the emergency department with abdominal pain and general malaise. She describes the pain as epigastric and a little in the back. She denies any vomiting. Realizing that pathology sometimes presents atypically in the elderly, you perform a RUQ ultrasound. This is what you see:
Other than noticing that someone left the “GB TV” label for images which are not, in fact, transverse gallbladder, do you see positive findings?
Yes, there are layering gallstones (cholelithiasis) in the fundus, wall edema, and a thickened gallbladder wall. The patient did have a positive sonographic Murphy sign. More concerningly, pay attention to the anterior gallbladder wall and the hyperechoic foci with gray shadowing. This is air!
Emphysematous cholecystitis is much less common but carries a much higher mortality rate than garden variety cholecystitis. It is caused by gas-producing organisms such as Clostridium or E. coli and is a surgical emergency.