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Case of the Week 590



What is the most likely diagnosis?

  • 62 year-old male with right upper quadrant pain



Frontal Radiograph of Abdomen

  1. Situs inversus
  2. Free air
  3. Splenic artery aneurysm
  4. Emphysematous cholecystitis
  5. Volvulus

Additional image - None

 

 

Additional Images

 


None


Answer:

 

4. Emphysematous cholecystitis

 

More (Click Discussion Tab)

 

 

Emphysematous cholecystitis

 

General Considerations

  • Acute infection of gallbladder caused by gas-forming organism
    • In about 1/3 = clostridium perfringens
    • Also E. Coli and Klebsiella
  • Rare – only 1% of all cases of acute cholecystitis
  • Occurs more often in men
    • As opposed to gallbladder disease in general which occurs more often in women
  • Mostly are elderly patients (>60) with diabetes
  • Vascular compromise of the cystic artery may play a role in the etiology
    • Gallstones may be associated with the disease but are not thought to cause it
  • Gas may occur in the wall and/or the lumen
    • May spread to pericholecystic tissue
    • Rarely, gas may escape into the bile ducts
      • This is rare since cystic duct is usually occluded in cholecystitis

MORE . . .

 


.

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