Emphysematous cholecystitis: sonographic findings.

Abstract

Emphysematous cholecystitis (EC) is a rare but life-threatening complication of acute cholecystitis, and an early diagnosis is required to prevent delay in patient management. Because sonography (US) is the first choice for diagnosing gallbladder diseases, US findings of EC should be understood more precisely. We reviewed US findings of 11 surgically proven cases of EC (with small amounts of gas in three cases and large amounts in eight cases) and compared those with patients' clinical data. (1) In cases with small amounts of gas, US showed an echogenic line with a distinct ring-down artifact or a "powder snow-like" speckled posterior echo. (2) In cases with large amounts of gas, US showed a wide spiculated echogenic band with a powder snow-like speckled posterior echo or a speckled acoustic shadowing. In all cases, the presence of gas prevented visualization of the gallbladder wall. (3) US did not differentiate gas localized to the gallbladder wall and gas extending to the surrounding hepatic tissue. (4) Two diabetic cases showed gas throughout the intrahepatic bile ducts. In those cases, the time from diagnosis to recovery was relatively long. 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.