Case v -  Cholecystitis

The gallbladder is distended.  There is gallbladder edema and and pericholecystic stranding.  The findings indicate acute cholecystitis.

In this case the gall bladder is distended.  It is ovoid on all slices.  It does not flop over onto itself.  It looks like there is some internal pressure.  There is edema which is seen as low attenuation fluid in the wall peripheral to the thin, enhancing mucosa.  There is an extensive amount of stranding in the fat surrounding the gall bladder (1, 2, 3).  This is best seen on a coronal image where there is stranding around the gall bladder neck and fundus.  There is even slight duodenal wall thickening, which is not unexpected given the adjacent inflammation.  In this instance there is no peri-hepatic hyperemia.

Each of these findings are, individually, non-specific for cholecystitis.  Gall bladder distension can be seen with fasting or in patients on TPN.  Gall bladder edema can be seen with cirrhosis, congestive heart failure, hepatitis, and low protein states.  The pericholecystic stranding is more specific for cholecystitis but can be seen in pancreatitis, colitis (in the adjacent hepatic flexure), duodenitis, or trauma.  The combination of findings, and the fact that the stranding is centered about the gall bladder, indicate cholecystitis.  This was confirmed at surgery.

There is also some peri-hepatic fluid which is of uncertain significance.  It likely is secondary to the inflammation surrounding the gall bladder and I do not believe its presence is significant.  Did you find the normal, air filled appendix?

Take home point:

• The combination of gall bladder distension, gall bladder wall edema, and pericholecystic fatty stranding indicated cholecystitis.