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Urushidani S, Kuriyama A. A Patient With Right Upper Quadrant Pain. Ann Emerg Med 2022; 80:e27-e28. [PMID: 35995527 DOI: 10.1016/j.annemergmed.2022.04.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2022] [Indexed: 11/25/2022]
Affiliation(s)
- Seigo Urushidani
- Emergency and Critical Care Center, Kurashiki Central Hospital, Kurashiki, Japan
| | - Akira Kuriyama
- Emergency and Critical Care Center, Kurashiki Central Hospital, Kurashiki, Japan
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2
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Yamanoğlu A, Bilgin S, Çelebi Yamanoğlu NG, Topal FE. A Rare Ultrasonographic Finding of Emphysematous Cholecystitis: The Champagne Sign. J Emerg Med 2021; 60:e151-e153. [PMID: 33640216 DOI: 10.1016/j.jemermed.2021.01.036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Revised: 01/15/2021] [Accepted: 01/23/2021] [Indexed: 11/19/2022]
Abstract
BACKGROUND Emphysematous cholecystitis (EC) is a form of cholecystitis with high mortality rates more commonly seen in patients with medical histories such as diabetes, hypertension, and peripheral vascular disease. The common features of these medical diseases are impaired pain perception, particularly abdominal pain, due to advanced age and peripheral neuropathies. Accurate evaluation of characteristics observed at ultrasonography, the method of first choice in the diagnosis of EC, is therefore highly important in these patients. CASE REPORT This study reports a case of the champagne sign, rarely seen in EC, together with other EC findings. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: The champagne sign is a little-known sonographic finding that is evidence of the presence of gas in the gallbladder. The champagne sign that will be detected while evaluating the hepatobiliary system on bedside ultrasound is one of the valuable findings in the diagnosis of emphysematous cholecystitis with high mortality.
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Affiliation(s)
- Adnan Yamanoğlu
- Department of Emergency Medicine, Izmir Katip Celebi University, Ataturk Training and Research Hospital, Izmir, Turkey
| | - Serkan Bilgin
- Department of Emergency Medicine, Izmir Katip Celebi University, Ataturk Training and Research Hospital, Izmir, Turkey
| | | | - Fatih Esad Topal
- Department of Emergency Medicine, Izmir Katip Celebi University, Ataturk Training and Research Hospital, Izmir, Turkey
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3
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A pictorial review of gall stones and its associated complications. Clin Imaging 2020; 60:228-236. [DOI: 10.1016/j.clinimag.2019.11.015] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2019] [Revised: 10/13/2019] [Accepted: 11/04/2019] [Indexed: 01/11/2023]
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4
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A deceptive case of emphysematous cholecystitis complicated with retroperitoneal gangrene and emphysematous pancreatitis: clinical and computed tomography features. Pol J Radiol 2019; 84:e41-e45. [PMID: 31019593 PMCID: PMC6479146 DOI: 10.5114/pjr.2019.82858] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2018] [Accepted: 12/17/2018] [Indexed: 11/24/2022] Open
Abstract
Purpose Emphysematous cholecystitis (EC) is an uncommon, severe variant of acute cholecystitis caused by gas- forming bacteria – most often Clostridium perfringens and Escherichia coli. We present a deceptive case of EC associated with retroperitoneal gas gangrene and emphysematous pancreatitis. Case report An 86-year-old, overweight woman was admitted to the emergency department with non-specific abdominal symptoms. Admission laboratory tests showed elevated diastase levels indicating acute pancreatitis. Computed tomography (CT) demonstrated a substantial amount of gas in the retroperitoneum and peritoneal cavity, which raised a suspicion of duodenal perforation. Primary diagnosis was not confirmed during emergency laparotomy, which revealed a gangrenous gallbladder adjacent to the duodenum and surrounded by purulent fluid. The final diagnosis established after laparotomy and rereading of CT scans was that of emphysematous cholecystitis associated with gangrenous pancreatitis and retroperitoneal gangrene. After surgery, the patient was transferred to the intensive care unit in septic shock. Shortly after, the second laparotomy was undertaken on suspicion of internal bleeding. During surgery, the patient experienced cardiac arrest and died despite immediate resuscitation. Conclusions Emphysematous cholecystitis may be associated with a spread of infection both to the peritoneal cavity and retroperitoneum and result in a substantial amount of gas in those anatomic compartments. The knowledge of this rare complication may be helpful in establishing a correct diagnosis.
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Yao Z, Zheng J, Si Y, Xu X, Li T. Spontaneous Hepatic Hemorrhage Caused by Emphysematous Cholecystitis: A Case Report and Literature Review. Surg Infect (Larchmt) 2018; 20:247-250. [PMID: 30351236 DOI: 10.1089/sur.2018.196] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Emphysematous cholecystitis and spontaneous hepatic hemorrhage are uncommon and serious conditions with non-specific presentations that can lead to a poor clinical outcome. We report a case of spontaneous hepatic hemorrhage of emphysematous cholecystitis. A 49-year-old male presented to the emergency department with fever, chills, right upper quadrant pain, vomiting, and diarrhea of four days' duration. He had a history of diabetes mellitus, hypertension, and uarthritis. Computed tomography (CT) revealed an enlarged gallbladder with intra-luminal, intra-mural, and peri-cholecystic air; subcapsular high-density fluid collection; and an intra-hepatic mass with gas and liquid in the right lobe of the liver. After receiving prompt administration of appropriate antibiotic agents, drainage, and an alternative operation the patient recovered well. CONCLUSION Emphysematous cholecystitis is potentially fatal because of its serious complications. It needs to be diagnosed promptly, not only based on the effervescent gallbladder sign but also on the inflammatory presentations. Furthermore, for patients with spontaneous hepatic hemorrhage, attention should be paid to the underlying cause. Treatment should be individualized to improve diagnosis and cure as early as possible, thereby improving prognosis.
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Affiliation(s)
- Zhoujia Yao
- 1 HBP Department, Zhuji People's Hospital , Zhuji, Shaoxin, Zhejiang Province, China
| | - Jun Zheng
- 1 HBP Department, Zhuji People's Hospital , Zhuji, Shaoxin, Zhejiang Province, China
| | - Youguang Si
- 1 HBP Department, Zhuji People's Hospital , Zhuji, Shaoxin, Zhejiang Province, China
| | - Xudong Xu
- 2 Ultrasound Department, Zhuji People's Hospital , Zhuji, Shaoxin, Zhejiang Province, China
| | - Tingting Li
- 3 Zhuji Central Hospital , Zhuji, Shaoxin, Zhejiang Province, China
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Wexler BB, Panebianco NL. The Effervescent Gallbladder: An Emergency Medicine Bedside Ultrasound Diagnosis of Emphysematous Cholecystitis. Cureus 2017; 9:e1520. [PMID: 29104833 PMCID: PMC5647163 DOI: 10.7759/cureus.1520] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Emphysematous cholecystitis (EC) is a distinct clinical disease that carries a high rate of morbidity and mortality. Maintaining a high index of suspicion, especially in the right patient population, combined with emergency bedside ultrasound can lead to rapid diagnosis and initiation of treatment for this life threatening condition.
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Affiliation(s)
- Brian B Wexler
- Department of Emergency Medicine, The Hospital of the University of Pennsylvania
| | - Nova L Panebianco
- Department of Emergency Medicine, The Hospital of the University of Pennsylvania
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8
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Rodríguez ÁL, Pavón RF, Rionda PJ, Flores PA, González AF, Gutiérrez CL, Martín DB. "The Effervescent Gallbladder": A Rare Ultrasonographic Finding that Reflects the Presence of Gas within the Gallbladder. Ultrasound Int Open 2016; 1:E72-5. [PMID: 27689157 DOI: 10.1055/s-0035-1564155] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2015] [Accepted: 08/17/2015] [Indexed: 10/22/2022] Open
Abstract
This article deals with the "effervescent gallbladder", a rare ultrasonographic finding indicative of the presence of gas within the gallbladder. 3 cases are described and illustrated with photographs. Possible causes are reviewed and discussed.
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Affiliation(s)
- Á Lozano Rodríguez
- Radiología, Complejo Hospitalario Universitario Insular Materno-Infantil, Las Palmas de Gran Canaria, Spain
| | - R Fuentes Pavón
- Radiología, Complejo Hospitalario Universitario Insular Materno-Infantil, Las Palmas de Gran Canaria, Spain
| | - P Junguera Rionda
- Radiología, Complejo Hospitalario Universitario Insular Materno-Infantil, Las Palmas de Gran Canaria, Spain
| | - P Alemán Flores
- Radiología, Complejo Hospitalario Universitario Insular Materno-Infantil, Las Palmas de Gran Canaria, Spain
| | - A Fuentes González
- Complejo Hospitalario Universitario Insular Materno-Infantil, Service of Anaesthesiology and Resuscitation, Las Palmas de Gran Canaria, Spain
| | - C López Gutiérrez
- Radiología, Complejo Hospitalario Universitario Insular Materno-Infantil, Las Palmas de Gran Canaria, Spain
| | - D Batista Martín
- Radiología, Complejo Hospitalario Universitario Insular Materno-Infantil, Las Palmas de Gran Canaria, Spain
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Ohno H, Ishida H, Komatsuda T, Matsuda A, Watanabe T. Asymptomatic emphysematous cholecystitis. J Med Ultrason (2001) 2009; 36:153-6. [PMID: 27277229 DOI: 10.1007/s10396-009-0223-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2008] [Accepted: 04/15/2009] [Indexed: 11/26/2022]
Abstract
Emphysematous cholecystitis (EC) is a life-threatening complication of acute cholecystitis. Its clinical manifestations are usually vague, but asymptomatic cases are very rare. We present such a case with an emphasis on sonographic (US) findings. In this case, detection of gas echoes in the gallbladder wall and the surrounding hepatic tissue led us to an appropriate treatment. US is now the technique of first choice for diagnosing gallbladder diseases, and knowledge of US findings encountered in this case can help prevent a hazardous delay in emergent treatment.
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Affiliation(s)
- Hideo Ohno
- Department of Gastroenterology, Red Cross Hospital, 222-1 Naeshirozawa, Saruta, Kamikitate, Akita, 010-1495, Japan.
| | - Hideaki Ishida
- Department of Gastroenterology, Red Cross Hospital, 222-1 Naeshirozawa, Saruta, Kamikitate, Akita, 010-1495, Japan
| | - Tomoya Komatsuda
- Department of Gastroenterology, Red Cross Hospital, 222-1 Naeshirozawa, Saruta, Kamikitate, Akita, 010-1495, Japan
| | - Akina Matsuda
- Department of Gastroenterology, Red Cross Hospital, 222-1 Naeshirozawa, Saruta, Kamikitate, Akita, 010-1495, Japan
| | - Takako Watanabe
- Department of Gastroenterology, Red Cross Hospital, 222-1 Naeshirozawa, Saruta, Kamikitate, Akita, 010-1495, Japan
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10
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Bernstein D, Soeffing J, Daoud YJ, Fradin J, Kravet SJ. The obscured gallbladder. Am J Med 2007; 120:675-7. [PMID: 17679125 DOI: 10.1016/j.amjmed.2007.04.012] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2006] [Revised: 04/27/2007] [Accepted: 04/27/2007] [Indexed: 11/24/2022]
Affiliation(s)
- Douglas Bernstein
- Johns Hopkins University School of Medicine, Baltimore, Md 21224, USA
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11
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Abstract
The use of ultrasound technology in the emergency department(ED) is a recent and fast-growing phenomenon. Ultrasound is an extremely valuable tool for the evaluation of gallbladder (GB) dis-ease in the ED for several reasons: this disease is a common medical problem, cholecystitis can present in different ways clinically,the nature of the GB allows it to be well visualized by ultrasound,and ultrasound has many benefits and few complications associated with its use. This article reviews the focused examination of the GB, with specific attention to test characteristics (sensitivity,specificity, positive predictive value, and negative predictive value)when performed by emergency physicians in the ED.
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Affiliation(s)
- Kaushal Shah
- St. Luke's-Roosevelt/Columbia University, Department of Emergency Medicine, University Hospital of Columbia University College of Physicians and Surgeons, 1111 Amsterdam Avenue, New York, NY 10025, USA.
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12
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Koenig T, Tamm EP, Kawashima A. Magnetic resonance imaging findings in emphysematous cholecystitis. Clin Radiol 2004; 59:455-8. [PMID: 15081852 DOI: 10.1016/j.crad.2003.10.023] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- T Koenig
- Department of Radiology, The University of Texas-Houston Medical School, Houston, TX, USA
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13
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Epigastralgia en paciente diabético. Rev Clin Esp 2004. [DOI: 10.1016/s0014-2565(04)71405-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Grayson DE, Abbott RM, Levy AD, Sherman PM. Emphysematous infections of the abdomen and pelvis: a pictorial review. Radiographics 2002; 22:543-61. [PMID: 12006686 DOI: 10.1148/radiographics.22.3.g02ma06543] [Citation(s) in RCA: 191] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Emphysematous (gas-forming) infections of the abdomen and pelvis represent potentially life-threatening conditions that require aggressive medical and often surgical management. The initial clinical manifestation of these entities may be insidious, but rapid progression to sepsis will occur in the absence of early therapeutic intervention. Conventional radiography and ultrasonography are often the initial imaging modalities used to evaluate patients with abdominopelvic complaints. However, when a differential diagnosis remains, or if further localization or confirmation of tentative findings is needed, computed tomography (CT) should be considered the imaging modality of choice. CT is both highly sensitive and specific in the detection of abnormal gas and well suited to reliable depiction of the anatomic location and extent of the gas. Of equal importance may be the capability of CT to help reliably identify benign sources of gas, because treatment (if any) varies dramatically depending on the source. Knowledge of the pathophysiologic characteristics, common predisposing conditions, and typical imaging features associated with gas-forming infections of the gallbladder, stomach, pancreas, and genitourinary system will help make early diagnosis and successful treatment possible. In addition, such knowledge will aid in further diagnostic work-up, surveillance of potential complications, and evaluation of therapeutic response.
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Affiliation(s)
- David E Grayson
- Department of Radiology, Wilford Hall Medical Center, 759th MDTS/MTRD, 2200 Bergquist Dr, Suite 1, Lackland AFB, TX 78236-5300, USA.
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15
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Affiliation(s)
- R Sharma
- Department of Radiodiagnosis, All India Institute of Medical Sciences, Ansari Nagar, New Delhi 110027, India
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16
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Wu CS, Yao WJ, Hsiao CH. Effervescent gallbladder: sonographic findings in emphysematous cholecystitis. JOURNAL OF CLINICAL ULTRASOUND : JCU 1998; 26:272-275. [PMID: 9608373 DOI: 10.1002/(sici)1097-0096(199806)26:5<272::aid-jcu9>3.0.co;2-9] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
Abstract
We report a case of emphysematous cholecystitis with the sonographic appearance of an "effervescent gallbladder"--a large amount of gas bubbles rising like bubbles in a glass of champagne from the dependent part of the gallbladder and floating to the nondependent part. The etiology of this finding was acute obstruction of the distal common bile duct by a stone and purulent cholangitis. Short-term follow-up sonography is important to confirm the diagnosis of cholecystitis.
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Affiliation(s)
- C S Wu
- Department of Radiology, Military General Hospital, Kaoshiung, Taiwan
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17
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Abstract
Emphysematous cholecystitis is a variant of acute cholecystitis characterized by the presence of gas in the gall bladder lumen, wall or pericholecystic tissues in the absence of an abnormal communication between the biliary system and the gastrointestinal tract. In the past, the diagnosis has relied on the plain abdominal radiograph (AXR), since there are no clinical features to separate this condition from simple acute cholecystitis. The apparently high mortality and morbidity associated with emphysematous cholecystitis has previously emphasized the importance of emergency cholecystectomy. We have reviewed eight cases of emphysematous cholecystitis presenting to this hospital over the last 5 years. The diagnosis was made on AXR in only one of these cases. Ultrasound (US) scans were performed in all eight cases, of which five were positive and three negative, due to non-visualization of the gall bladder. In the three negative cases, the diagnosis was made on subsequent CT scans. On initial clinical examination, only one of the eight patients appeared systemically unwell and conservative management was employed in five of the patients. The remaining three patients underwent cholecystectomy within 3-5 days because of continuing signs or symptoms. It is concluded that the AXR is relatively insensitive in the diagnosis of emphysematous cholecystitis. As a result of the regular use of US in suspected hepatobiliary disease, emphysematous cholecystitis is being diagnosed with increased frequency, uncovering a broad spectrum of disease ranging from mild to severe. Previously, failure to separate milder cases from simple acute cholecystitis may have been responsible for reports of unremitting severity and progression requiring emergency cholecystectomy. Based on clinical assessment, conservative surgical management is possible in a significant proportion of patients.
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Affiliation(s)
- K S Gill
- Department of Radiology, St James's University Hospital, Leeds, UK
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Coffin CT, Weingardt JP, Drose JA. The Sonographic Appearance of Emphysena tous Cholecys titis. JOURNAL OF DIAGNOSTIC MEDICAL SONOGRAPHY 1995. [DOI: 10.1177/875647939501100408] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Emphysematous cholecystitis is an uncommon form of acute gangrenous cholecystitis. It is characterized by as within the gallbladder wall, lumen, or bliliary ducts. The morbidity associated with emphysematous cholecystitis is five times that of nonemphysematous cholecystitis'. The timely diagnosis ant management of this entity may substantialty reduce the associated morbaidty anc mortality. The sonographic findings ot emphysematous ch oecystitis, including ecnogenic material with shadowing within the gallblader and reverberation echoes emanating from the gallbladder wall or lumen, have been well documented.2-7 We report a case that illustrates an additional rare sonograpnic finding of gas bubbles arising from the gallbladder wall.
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Affiliation(s)
- Carolyn T. Coffin
- Division of Diagnostic Ultrasound, C-277, University of Colorado Health Sciences Center, 4200 E. Ninth Avenue, Denver, CO 80262
| | | | - Julia A. Drose
- Division of Diagnostic Ultrasound, University of Colorado Health Sciences Center, Denver, Colorado
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19
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Mlkvy KL, Horrow M. Emphysematous Cholecystitis. JOURNAL OF DIAGNOSTIC MEDICAL SONOGRAPHY 1994. [DOI: 10.1177/875647939401000307] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Emphysematous cholecystitis is a rare form of acute cholecystitis. This condition is characterized by the presence of gas-forming bacteria in the gallbladder wall, lumen, and bile ducts. This disorder can have a variety of sonographic appearances. Recognition of the gas is important for sufficient treatment of this disease, which carries a high risk of mortality. Differential diagnoses and the results of previous studies of this condition are discussed.
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Affiliation(s)
- Kerri-Lyn Mlkvy
- Department of Diagnostic Imaging, Thomas Jefferson University
| | - Mindy Horrow
- Albert Einstein Medical Center, Philadelphia, Pennsylvania
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Jolly BT, Love JN. Emphysematous cholecystitis in an elderly woman: case report and review of the literature. J Emerg Med 1993; 11:593-7. [PMID: 8308239 DOI: 10.1016/0736-4679(93)90315-x] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
Cholecystitis, a frequent diagnosis in emergency departments, has been discussed extensively in the medical literature. We report a case of emphysematous cholecystitis, an unusual form of this disease process, including the classic radiographic findings. We also offer a review of the literature, emphasizing the proposed pathophysiology and the life-threatening nature of this surgical condition. Early recognition and surgical consultation are vital in these patients.
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Affiliation(s)
- B T Jolly
- Department of Emergency Medicine, George Washington University Medical Center, Washington, DC
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Bloom RA, Craciun E, Lebensart PD, Levy P, Ziv JB. The ultrasound appearances of intramural bowel gas: the bright ring appearance and the effervescent bowel. A report of three cases. Br J Radiol 1992; 65:585-8. [PMID: 1515895 DOI: 10.1259/0007-1285-65-775-585] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
Bowel necrosis is a serious condition with a very high mortality rate. The earlier the diagnosis is made, the better chance for survival. Ultrasound is a primary imaging technique in the diagnosis of the acute abdomen. Three cases are presented in which bowel wall gas could be demonstrated on ultrasound. In all cases there was computed tomographic and either operative or post-mortem correlation. In each case there was a "bright ring" appearance of the affected bowel when the ultrasound examination was carried out in transverse section. In one case, small bubbles were seen arising from the deep surface of the bowel.
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Affiliation(s)
- R A Bloom
- Department of Radiology, Hadassah University Hospital, Jerusalem, Israel
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23
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Cohen SM, Kurtz AB. Biliary Sonography. Radiol Clin North Am 1991. [DOI: 10.1016/s0033-8389(22)02472-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Franquet T, Bescos JM, Barberena J, Montes M. Acoustic artifacts and reverberation shadows in gallbladder sonograms: their cause and clinical implications. GASTROINTESTINAL RADIOLOGY 1990; 15:223-8. [PMID: 2187731 DOI: 10.1007/bf01888781] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
From among more than 7000 sonographic examinations of the gallbladder performed over a period of 2 years, different types of acoustic artifacts were observed in 42 patients. Artifacts originated in the gallbladder wall in 37 cases and within the lumen in 5 cases. Eighteen patients had symptoms related to the hepatobiliary area. Twenty-four patients were fully asymptomatic although cholelithiasis was demonstrated in 8. In 21 cases (50%) some type of gallbladder pathology was associated with the presence of acoustic artifacts. Thirteen patients were cholecystectomized and the associated gallbladder pathology consisted of cholelithiasis (N = 5), cholesterolosis (N = 2), adenomyomatosis (N = 2), emphysematous cholecystitis (N = 2), and acute cholecystitis (N = 2). In 3 of these patients a sonographic/pathologic correlation was established. Only 5 of the 18 symptomatic patients presented acoustic artifacts in an otherwise normal gallbladder. Recognition of those pathological conditions favorable to the appearance of artifacts and reverberation shadows is extremely useful for differentiating merely clinically irrelevant anomalies from those that require prompt management.
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Affiliation(s)
- T Franquet
- Department of Radiology, Hospital Virgen del Camino, Pamplona, Spain
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Abstract
We report a case of a gas forming renal abscess in which real time ultrasound demonstrated intravascular gas originating in the abscess passing into the inferior vena cava and hepatic veins.
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Affiliation(s)
- P N James
- Department of Diagnostic Radiology, Leeds General Infirmary
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