Emphysematous CholecystitisPricilia Donna Esperansa Sea – 2012 060 106

Emphysematous Cholecystitis

• EC is a severe form of acute colesystitis.• Rapidly fatal, risk for gangrene and perforation, high risk

mortality.• Life-threathening anaerobic infection. Gas-forming

bacteria (Clostridium welchii/perfingrens, Escherichia coli and Bacteroides fragilis)• Men are affected twice as commonly as women. Mostly

patients are between 50 and 70 years of age, and have underlying diabetes melitus.• Can be detected using CT or USG. Gas in gallblader or

abnormal communication with GIT• Pain in right upper quadrant.

Plain Abdominal Radiograph

Abdominal radiograph (frontal projection) shows intraluminal air (arrow) with air–fluid levels

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3137852/#!po=50.0000

USG

Sagittal (A) and axial (B) USG images show sludge (black arrow) and wall thickening (arrow in A) of the gall bladder, consistent with acute cholecystitis with echogenic shadowing foci (arrow in B) within the biliary system

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3137852/#!po=50.0000

Sagittal USG image of the gall bladder shows multiple speckled echogenic bands (arrows), with acoustic shadowing within its wall (arrowhead)

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3137852/#!po=50.0000

CT

Axial CT scan shows air (arrow) in the gall bladder lumen with an air–fluid level

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3137852/#!po=50.0000

Axial CT scan shows intramural air in the gall bladder (arrow), with cholelithiasis (arrowhead)

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3137852/#!po=50.0000

Emphysematous cholecystitis in a 47-year-old man with diabetes who experienced abdominal pain. This computerized tomography scan shows gas within the wall of the gallbladder (horizontal arrow) as well as within the lumen of the gallbladder (vertical arrow). Courtesy of Helen Morehouse, MD.

http://emedicine.medscape.com/article/173885-overview#aw2aab6c10

Axial CT scan (A) shows an inflamed gall bladder with questionable air in the gall bladder wall (arrow). Coronal reformation (B) confirms air within the gall bladder wall (arrow) suggesting emphysematous cholecystitis

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3137852/#!po=50.0000

MRI

Coronal heavily T2-weighted magnetic resonance image shows numerous signal void bubbles (arrowheads) in the lumina of the distended gallbladder and the common bile duct.Courtesy of Radiological Society of North America (RSNA), originally published in Watanabe Y, Nagayama M, Okumura A, et al. MR imaging of acute biliary disorders. RadioGraphics 2007;27:477-95.

http://emedicine.medscape.com/article/173885-overview#aw2aab6c10

Daftar Pustaka• Emphysematous Cholecystitis. April 9, 2015 [cited May 12, 2015];

Retrieved from: http://emedicine.medscape.com/article/173885-overview

• Sunnapwar A, Raut AA, Nagar AM, Katre R. Emphysematous cholecystitis: Imaging findings in nine patients. Indian J Radiol Imaging. 2011;21(2):142–6.

• http://radiopaedia.org/articles/emphysematous-cholecystitis