Abdominal ultrasound (StatPearls: Chronic Cholecystitis [Accessed 19 February 2020]) 44 year old man with gallstones and chronic cholecystitis revealing metachronous gallbladder metastasis from renal clear cell carcinoma Variable mucosal appearance: can be granular, ulcerated, polypoid Gross images Ultrasound appearance of XGC and GBC that manifested as solid masses. (A) A case of XCG manifesting as a solid mass on ultrasound (within the black arrows). There were small hypo-echoic nodules and hyper-echoic foci in the lesion, resulting in the heterogeneity of the lesion The most sensitive US finding in acute cholecystitis is the presence of cholelithiasis in combination with the sonographic Murphy sign. Both gallbladder wall thickening (>3 mm) and pericholecystic fluid are secondary findings. Other less specific findings include gallbladder distension and sludge
Chronic cholecystitis is a term used clinically to refer to symptomatic gallbladder stones that cause transient obstruction, leading to a low-grade inflammation with fibrosis. Correlation of the imaging finding of a stone-containing slightly thick-walled gallbladder with the clinical history is critical . If this condition persists for a prolonged period of time or if you have repeated attacks, it is called chronic. Chronic cholecystitis Bates J A. Abdominal Ultrasound: How, Why and When. Churchill Livingstone, Edinburg, UK, 2nd edition, 2004 Thick gallbladder wall Small gallbladder stone with posterior AS Bouts of acute cholecystitis may complicate chronic cholecystitis 38 Chronic Cholecystitis. Abdominal ultrasound-standard diagnostic exam for gallstones It produces the classic macroscopic appearance of a strawberry gallbladder Granulomatous polyps. develop in the lumen at the fundus; the gallbladder wall is thickened, and septa or strictures may be seen.
Ultrasound can confirm the diagnosis of acute cholecystitis and distinguish it from chronic cholecystitis with an accuracy of 95% to 99%. The disadvantages of radionuclide scintigraphy include the time to perform the examination (up to 4 hours) and the inability to evaluate for nonbiliary conditions Ultrasound: The sensitivity of ultrasound in the detection of acute cholecystitis is 95% and the specificity is 78-80%. The combination of gallstones and a positive sonographic Murphy's sign has a positive predictive value for acute cholecystitis of as high as 90-96% Chronic cholecystitis was diagnosed based on appearance of prior inflammation, including fibrin deposition and wall thickening (in particular, the muscularis propria). Microscopically, the presence of Rokitansky-Aschoff sinusosis, metaplastic epithelial changes, macrophages, lymphocytes, and plasma cells were diagnostic of chronic cholecystitis 2. Paivansalo M, et al. Ultrasound in acute and chronic cholecystitis. Rofo Forts Geb Rontgen Nuklearmed. 1987; 147(1):84-7. 3. Soiva M, et al. Ultrasonography of the gallbladder in patients with a clinical suspicion of acute cholecystitis. Diagn Imaging Clin Med. 1986;55(6):337-42. 4 Chronic calculous cholecystitis with cholesterolosis. (a, b) Arterial phase (a) and portal venous phase (b) images show mild thickening of whole gallbladder wall and slight contraction of the lumen (arrows). However, the presence of stone cannot be determined on these CT images
Chronic cholecystitis is a chronic condition caused by ongoing inflammation of the gallbladder resulting in mechanical or physiological dysfunction its emptying. It presents as a smoldering course that can be accompanied by acute exacerbations of increased pain (acute biliary colic), or it can progress to a more severe form of cholecystitis requiring urgent intervention (acute cholecystitis) Hence cholecystitis supervenes. The clinical presentation is usually a patient in the ICU who has a fever of unknown origin or who has right upper quadrant pain or tenderness with a positive Murphy's sign. From an imaging standpoint, ultrasound is the study of choice since According to the researchers at an exacerbation of chronic cholecystitis the pH of the gall bladder can be 4.0-5.5. The appearance of crystals of cholesterol and calcium bilirubinate. Chronic cholecystitis is characterized by the appearance of crystals of cholesterol and calcium bilirubinate
. Although ultrasound is the first diagnostic imaging procedure, frequently the initial imaging modality is computed tomography (CT). Therefore, familiarization of CT findings in AC and potential related complications are extremely important Chronic cholecystitis. Chronic cholecystitis is swelling and irritation of the gallbladder that continues over time. The gallbladder is a sac located under the liver. It stores bile that is made in the liver. Bile helps with the digestion of fats in the small intestine
ACUTE CALCULOUS CHOLECYSTITIS. Sonographic Examination of Gallbladder: over the gallbladder when pressure is applied by the ultrasound transducer. Gangrenous cholecystitis may cause necrosis and denervation of afferent nerve fibers from the gallbladder and result in a negative sonographic Murphy's sign. , and chronic cholecystitis. Endoscopic ultrasound [EUS] is more sensitive in detecting the early changes of chronic alcoholic pancreatitis. A study by Kahl, et al reported 100% sensitivity in detecting the changes associated with early chronic pancreatitis by EUS even when endoscopic retrograde cholangio-pancreatography [ERCP] was normal Chronic acalculous cholecystitis with biliary sludge is an inflammatory disease, which affects the gallbladder wall and causes motoric-tonic dysfunction of the biliary tract, which is accompanied by appearance of hyperechogenic particles in the gallbladder lumen and reveals as biliary pain (1, 2)
Xanthogranulomatous cholecystitis (XGC) is a rare inflammatory disease of the gallbladder characterized by severe proliferative fibrosis and the accumulation of lipid-laden macrophages in areas of destructive inflammation. Misdiagnosis is highly usual, and its macroscopic appearance may often be confused with gallbladder carcinoma. Here we discuss the case of a 56-year-old male who presented. The gallbladder is an oblong pear shaped structure located on the underside of the liver. It is located at the level of the middle hepatic vein aka Cantlie's line between segments IV and V. The normal distended gallbladder is approximately 7-10 cm in length and 4 cm in diameter. The capacity is usually 50 ml(1.
Chronic Pancreatitis •Chronic changes due to recurrent bouts of inflammation with resultant fibrosis, stone it gives a target appearance >6mm in diameter, usually between 7 and 10 mm. The wall thickness can be 3mm or more. •Cholecystitis has thickened GB wall and intermitten The normal gallbladder wall appears as a pencil-thin echogenic line on sonography. A thickened gallbladder wall measures more than 3 mm, and typically has a layered appearance at sonography (1). Differential diagnosis of diffuse gallbladder wall thickening: Cholecystitis (acute; chronic; acalculous; xanthogranulomatous •The ultrasound appearance of the GB are of a elongated pear-shaped cystic structure. •The gallbladder is well delineated and has smooth thin walls . •Gallstones may cause acute or chronic cholecystitis, biliary colic, pancreatitis or obstructive jaundice. •Biliary colic is the most common presentation
Chronic pain in the right upper abdomen Ultrasound Images & Clips Cholecystitis with a gallbladder filled with thick sludge and stones and a thick ill defined wall that after removal proved to be a chronic fibrosing cholecystitis a similar appearance. Acute Cholecystitis In the emergency setting, evaluation for acute cholecystitis is the most common indication for ordering RUQ sonography because clinical or laboratory parameters are unable to confirm or exclude this diagnosis without further imaging.5 Acute cholecystitis may have a wide range o A bedside ultrasound was performed in the ED. The findings showed a dilated CBD, thickened gallbladder wall up to 4 mm and pericholecystic fluid. The gallbladder had an interesting appearance in that it appeared septated with a stone lodged in the superior aspect of it. The patient was diagnosed with chronic cholecystitis In the emergency setting, evaluation for acute cholecystitis is the most common indication for ordering RUQ sonography because clinical or laboratory parameters are unable to confirm or exclude this diagnosis without further imaging. 5 Acute cholecystitis may have a wide range of appearances and severity, from gallbladder wall edema and.
The ultrasound appearance of acute on chronic hepatitis is even more confusing, making the diagnosis difficult or impossible on ultrasound; Think of underlying chronic hepatitis when you see: Enlarged liver (measuring > 15.5 cm craniocaudally in the midclavicular line), though this can be seen with acute hepatitis in an otherwise normal live Ultrasound can also see if abnormalities of the gallbladder, there are alterations in the liver parenchyma, thus allowing to make the distinction between pure and colangiohepatitis cholecystitis. Because these ultrasound findings do not serve to determine the etiology, it is necessary to resort to biopsy for diagnosis defi nite (Loriot et al. Patients with chronic cholecystitis may have malaise during the episode. The physical examination in chronic cholecystitis is remarkable for tender right upper quadrant, fever (usually low grade in uncomplicated cases) and a positive Murphy's sign. Physical Examination. Patients with chronic cholecystitis may have malaise during the episode Chronic cholecystitis must be differentiated from colitis, functional bowel syndrome, hiatal hernia, and peptic ulcer diseasse. Sharp and constant epigastric pain without fever. Liver function tests - increase in serum bilirubin, high conjugated bilirubin, raised GGT and ALP. An infection of entire biliary tract Chronic cholecystitis symptoms of the first group are regular and characteristic for exacerbation of chronic cholecystitis. The most pathognomonic are the symptoms of Mackenzie, Boas, Aliev. Chronic cholecystitis symptoms of the second group are due to the spread of irrigation of the autonomic nervous system beyond the segmentary innervation of.
Shrunken gallbladder - The gallbladder may shrink from chronic inflammation. The bile becomes viscid and sludge or gallstones may form causing loss of fluid in the GB and making it difficult to see. The GB can be filled with stones causing a wall-echo- shadow appearance Reference : abdominal ultrasound step by step Berthold Block 3rd editio Transverse scan of the gallbladder reveals circumferential thickening of the gallbladder wall (arrowheads). This appearance persisted in decubitus views. The postsurgical pathology report showed mild thickening and fibrosis of the wall, consistent with chronic cholecystitis. because they demonstrated ultrasonographic evidence of gallbladder. In chronic cholecystitis, the gall bladder is thickenedand degree of inflammation is variable. Cholesterolosis of the gall bladder is an uncommon condition in which yellow flecks are seen over the mucosal surface, giving an appearance known as the strawberry gall bladder Biliary ultrasound: Reveals calculi, with gallbladder and/or bile duct distension (frequently the initial diagnostic procedure). Oral cholecystography (OCG): Preferred method of visualizing general appearance and function of gallbladder, including presence of filling defects, structural defects, and/or stone in ducts/biliary tree ULTRASOUND STUDY GUIDE Technical knowledge o Physics and Safety, understand the following: 1) Physics of sound interactions in the body. 2) How transducers work, how the image is created, and what physical properties are being displayed. 3) Relative strengths and weaknesses of different transducers including various aspects of resolution
. Eighty-two patients, 35 with gallbladder carcinoma and 47 with chronic cholecystitis, underwent two-phase spiral CT. We reviewed the two-phase spiral CT. Hemorrhagic cholecystitis without calculous cholecystitis is an uncommon cause of abdominal pain. Blunt trauma, anticoagulation, spontaneous hemorrhage in patients with renal failure and cirrhosis, and angiosarcoma have all been described as causes of hemorrhagic cholecystitis. 1-3 Symptoms mimic calculous cholecystitis and include right upper quadrant pain, fever, and leukocytosis but may. Ultrasound findings in 2 cases of acute emphysematous cholecystitis are described. Reverberations were demonstrated within the acoustical shadow produced by gas in the gallbladder. Since reverberations are rarely seen within shadows produced by gallstones, a reverberation shadow arising from the gallbladder (in the absence of a biliary. Ultrasound of the gallbladder. The gallbladder is a pear-shaped bag 9 cm long with a capacity of about 50 ml.The gallbladder is divided into the fundus, body, and neck, with the fundus being the most anterior, and often inferior, segment.In the region of the neck, there may be an infundibulum, called Hartmann's Pouch, which is a common location.
It is a complication of chronic cholecystitis identified by imaging. Inflammatory scarring of the wall, combined with dystrophic calcification within the wal... Adenoma Case Study . Von Hippel-Lindau (VHL) disease is a genetic disorder characterized by visceral cysts and benign tumors in multiple organ systems The ultrasound image shown is suggestive of a biliary process, with a thick biliary wall and pericholecystic fluid, but further workup demonstrated a penetrating duodenal ulcer. A calcified gallbladder, also known as a porcelain gallbladder, is the result of chronic, long-standing inflammation
The presence of tracer in the duodenal cap, dilation of the cystic duct, or a duodenal diverticulum may be misinterpreted as GB filling. In appearance, chronic cholecystitis and AC may be indistinguishable. In only 4-8% of cases is the GB not visualized. Especially in patients with symptomatic, chronic cholecystitis is the GB not visualized Xanthogranulomatous cholecystitis (XGC) is an uncommon form of chronic cholecystitis, representing between 0.7% and 13.2% of gallbladder disease  and mainly affecting women between 60 and 70 years old. The term xanthogranulomatous cholecystitis was initially proposed by Goodman and Ishak  in 1981 in a review of 40 cases from the Armed. Chronic Cholecystitis. Sometimes a stone is trapped in the fundus of the gallbladder and it induces a chronic inflammatory process resulting in inflammation and subsequent fibrosis. A separate fundal chamber evolves, giving the gallbladder a figure of 8 appearance . Inflammation of an already scarred gallbladder wall can lead to perforation, particularly near stones. Pericholecystic edema or fluid can be present. This can look like wall edema caused by acute cholecystitis, Careful interrogation of the liver edge will aid visualization of free fluid in the RU
Cholecystitis is an inflammation of the gallbladder wall; it may be either acute or chronic. It is almost always associated with cholelithiasis, or gallstones, which most commonly lodge in the cystic duct and cause obstruction. Silent gallstones are so common that most of the American public may have them at some time; only stones that are. CHOLECYSTITIS (CHRONIC) osms.it/chronic-cholecystitis PATHOLOGY & CAUSES Obstruction of cystic duct (not infection) → inﬂammation of gallbladder wall Constant state of inﬂammation due to gallstones repeatedly blocking ducts Changes gallbladder mucosa → deep grooves (Rokatansky-Aschoff sinus) Pain esp. after meal; gallbladder attempts.
Etiology, Pathophysiology, and Clinical Manifestations of Cholecystitis What is Cholecystitis? Several disorders affect the biliary system and interfere with normal drainage of bile into the duodenum. Cholecystitis is the acute or chronic inflammation of the gallbladder. Classification There are two classifications of cholecystitis: Calculous cholecystitis Mar 19, 2020 - Explore rozana's board Xray on Pinterest. See more ideas about radiology, diagnostic medical sonography, sonography Definitions. • Hydrops: Distended gallbladder (GB) secondary to chronic obstruction filled with watery mucoid material. Content is usually sterile without GB inflammation. • Empyema: Pus-filled, inflamed, and distended GB secondary to acute cholecystitis with suppurative intraluminal infection
Acute cholecystitis is inflammation of the gallbladder that develops over hours, usually because a gallstone obstructs the cystic duct. Symptoms include right upper quadrant pain and tenderness, sometimes accompanied by fever, chills, nausea, and vomiting. Abdominal ultrasonography detects the gallstone and sometimes the associated inflammation Radiology. wall thickening (>3 mm), gallstone (s) in the neck. Prognosis. benign, good. Treatment. cholecystectomy. Acute cholecystitis, abbreviated AC, is a relatively uncommon gallbladder pathology when compared to chronic cholecystitis. It is usually associated with gallstones and seen in older individuals There were 693 cases of chronic cholecystitis, six mucocoeles, three empyemas, andtwocarcinomasof the gall bladder. Theage ofthe patients with XGCranged from 20 to 81 years with a mean of 63-2 years. This was significantly older thanthemeanage of57A4years of the patients with chronic cholecystitis (p <0-001). Seven patients with XGCwere female.
Gangrenous cholecystitis is the green-black appearance of the gallbladder as result of necrosis (tissue death). Gallbladder perforation is a tear or holes in the gallbladder that arises from a number of pathologies including chronic cholecystitis or severe acute cholecystitis Gallbladder adenomyomatosis is a benign epithelial proliferation while stones and cholecystitis secondary to gallbladder adenomyomatosis may lead to dysplastic changes and cancer 20). Most patients with gallbladder adenomyomatosis do not have typical symptoms and usually present chronic cholecystitis and vague abdominal pain, which complement. Definitions. Cholecystitis. Gallbladder inflammation resulting from cystic duct blockage by Gallstone s. Precautions. Acute Cholecystitis may present cryptically yet requires emergent management. Fever and chills are frequently absent. Fever or chills are only present in a third of patients with Acute Cholecystitis Chronic cholecystitis may be asymptomatic, may present as a more severe case of acute cholecystitis, or may lead to a number of complications such as gangrene, perforation, or fistula formation.   Xanthogranulomatous cholecystitis (XGC) is a rare form of chronic cholecystitis which mimics gallbladder cancer although it is not cancerous
Jan 6, 2020 - Cholelithiasis and pericholecystitis transverse. When autocomplete results are available use up and down arrows to review and enter to select - CC is a chronic inflammation of the gallbladder wall in the presence of gallstones with fibrosis of the wall, which disrupts normal motility and result in a contracted appearance (12) (Figure 14); Fig. 14 : Ultrasound image showing chronic inflammation of the gallbladder wall (6,33 mm), due to fibrosis, presence of gallstone, which produce a.
• CHRONIC CHOLECYSTITIS (CC) - CC is a chronic inflammation of the gallbladder wall in the presence of gallstones with fibrosis of the wall, which disrupts normal motility and result in a contracted appearance (12) (Figure 14); Fig. 14: Ultrasound image showing chronic inflammation of the gallbladder wal In one study of 52 patients with acute right upper quadrant pain suspected of having acute cholecystitis, the diagnosis was confirmed in only 34.6%, whereas 32.7% had chronic cholecystitis and 32.7% had normal gallbladders (, 1). Ultrasound (US) is the primary imaging modality used to evaluate acute right upper quadrant pain chronic cholecystitis, porcelain GB, choledochal cysts, primary sclerosing cholangitis, & GB polyps) carcinoma with ultrasound alone. GB carcinomas have the same sonographic appearance and symptoms as other diseases of the gallbladder While in chronic cholecystitis the gall bladder is small, contracted with stones and has thick fibrous echogenic wall. Ultrasonography is an important tool for diagnosing obstructive jaundice and locating the level and cause of obstruction (Fig-3,4) Cholecystitis on Ultrasound. Cholecystitis, or gallbladder inflammation, occurs when the gallbladder's drainage ducts are obstructed and the gallbladder becomes inflamed/infected. Cholelithiasis is the most common cause and primary risk factor for developing cholecystitis, implicated in up to 95% of cases of cholecystitis (Liau)
Cholecystitis is a redness and swelling (inflammation) of the gallbladder. It happens when bile becomes trapped and builds up in the gallbladder. In most cases this happens when solid lumps (gallstones) block the tube that drains bile from the gallbladder. In most cases you will be admitted to a hospital Chronic cholecystitis is a diagnosis based on CT findings. Gallstone ileus occurs when a gallstone passes through a cholecystoenteric fistula to cause mechanical bowel obstruction. Emphysematous cholecystitis is caused by the same organisms that cause acute cholecystitis. Question 4 Ultrasound images of Glomerulonephritis. Glomerulonephritis is an inflammatory condition which affects the glomeruli of the kidney. It may be either acute or chronic, and frequently follows prolonged infection. Patients may present in acute renal failure, with oliguria or anuria, or with features of nephrotic syndrome such as oedema. If the disease progresses to the chronic stage, the liver may reduce in size, becoming nodular and coarse in appearance (Fig. below). Ultrasound images Subtle changes of oedema in acute hepatitis: the liver is hypoechoic compared with the right kidney, mildly enlarged and has prominent portal tracts Pereira J, Afonso AC, Constantino J, et al. Accuracy of ultrasound in the diagnosis of acute cholecystitis with coexistent acute pancreatitis. Eur J Trauma Emerg Surg . 2015 Dec 22. [Medline]
For the diagnosis to take into account the history, the results of ultrasound( if necessary CT), biochemical indicators of bile and venous blood, as well as the results of coprology. A special method for diagnosing chronic cholecystitis is duodenal sounding, which can be used to investigate the composition of bile Ultrasound (US) is the first choice of investigation for biliary symptoms or right upper quadrant abdominal pain. for differentiating acute cholecystitis from gallstones alone and chronic cholecystitis with gallstones 4]. Although its sensitivity to some complications of cholecystitis is often limited, a normal appearance of the. Figure 2: Acalculous cholecystitis. (a) Prompt liver uptake with early appearance of activity in common bile duct and small bowel but not gallbladder (GB) up to 30 min postinjection. (b,c) No GB seen up to 60 min postinjection in the anterior and right lateral images. (d) GB seen 90 min postinjection The mean short and long diameter of the gallbladder in acute cholecystitis was significantly larger than in chronic cholecystitis (short diameter, 3.7 ± 0.9 vs 2.9 ± 1.1 cm; long diameter 9.6 ± 2.1 vs 7.6 ± 2.3 cm) (all, P < 0.001). Gallbladder wall thickness and bile attenuation did not exhibit significant differences between the groups
• Acute cholecystitis imaging is used primarily to look for evidence of inflammation and complications, as well as the presence of stones - Ultrasound is the most sensitive • The combination of stones and a positive sonographic Murphy's sign is highly suggestiv Ultrasound examination of the gallbladder is the method of choice to demonstrate stones and abnormalities in the gallbladder wall resulting from inflammation or fibrosis, or both. In chronic cholecystitis, the varied appearance of the gallbladder reflects the degree of inflammation and fibrosis. The gallbladder may be distended or shrunken.
Figure 01: Chronic Recurrent Cholecystitis. Management. As in chronic pancreatitis, the treatment of gallbladder attacks also varies according to the underlying cause of the disease. Lifestyle changes such as getting rid of obesity can be helpful in reducing the risk of gallbladder diseases Acute cholecystitis is a common surgical emergency and ultrasound (US) is currently considered the first-line diagnostic imaging test. The relative accuracy of computed tomography (CT) in detecting acute cholecystitis has received little attention in the literature. We report a case series of 113 patients who underwent emergency laparoscopic cholecystectomy at a tertiary surgical centre in. What results in an echogenic appearance with strong posterior acoustic shadowing in a GB? what ultrasound findings of emphysematous cholecystitis? Definition. comet tail (reverberation) artifacts are seen due to the presence of gas within the wall/lumen of the gb due to gas forming bacteria what is an unusual variant of chronic.
Case 3. Patient with ascites. Thickened GB wall 0.76cm, stone in neck of GB, ascites. Thickening of GB wall not due to cholecystitis but to pulmonary hypertension and liver failure. The stone in the neck of the GB makes this difficult to evaluate but the appearance of the GB had not changed over several months. Case 4 Chronic cholecystitis. Chronic cholecystitis is a term used clinically to refer to symptomatic gallbladder stones that cause transient obstruction, leading to a low-grade inflammation with fibrosis . Correlation of the imaging finding of a stone-containing slightly thick-walled gallbladder with the clinical history is critical Presence of cholesterol polyps may be indicative of pathologic gallbladder disease such as chronic cholecystitis. Inflammatory polyps account for 5% to 10% of all gallbladder polyps. They are associated with inflammation of the gallbladder mucosa and wall. Usually, this type is associated with repeated bouts of cholecystitis and acute biliary. Ultrasound appearance of normal uterus, endometrium and ovarian. Understanding endometrial and ovarian changes during menstrual cycles. Ability to locate submucosal intramural and subserosal fibroids, Adenomyosis and endometrial polyps. To diagnose polycystic ovaries, simple and complex ovarian cyst Cholecystitis can be chronic — persistent and long-lasting swelling and damage to the gallbladder — or acute, a sudden attack that causes swelling and irritation of the gallbladder
phils, and edema. Chronic cholecystitis was diagnosed based on appearance of prior inflammation, including fibrin depo-sition and wall thickening (in particular, the muscularis pro-pria). Microscopically, the presence of Rokitansky-Aschoff sinusosis, metaplastic epithelial changes, macrophages, lym Cholecystitis as generalized gall bladder wall thickening is associated with acute pyelonephritis, portal hypertension, chronic renal diseases, and hepatitis . Biliary sludge which is regarded as a precursor of cholecystolithiasis in humans is frequently identified as an incidental finding in canines, and its cause and clinical significance are. acteristic appearance of strawberry calcifica-tion. This has been reported to predict the risk of malignancy compared to those with diffuse intramural pattern. 3 with increased risk of gallbladder malignancy. The exact underlying pathogenesis is not known but is strongly associated with chronic inflammation of the gallbladder. Mos
Background Gallbladder carcinogenesis, frequently occurredin chronic cholecystitis patients, requires radical resection. We herein describe a hemorrhagic cholecystitis case that failed to be differentiated from gallbladder cancer preoperatively owing to the neglected medication history of long term oral nonsteroidal anti-inflammatory drugs (NSIADs) intake. Case presentation A 57-year-old. Ultrasound examination showed sediment and gas within the gallbladder, and a diagnosis of emphysematous cholecystitis was made. Emergency gallbladder resection was performed. Cytologic examination of bile fluid collected at surgery showed a mixed population of bacteria (bactibilia) together with fungal organisms consistent with Cyniclomyces. · Macroscopic appearance: enlarged (bigger than chronic), tense, covered by fibrin, contains turbid bile or puss. Wall is thick and oedematous and the mucosa is red or green-black (gangrenous cholecystitis, due to ¯ blood flow secondary to pressure) · Microscopic appearance: Acute inflammation, congestion, abscess, necrosi Chronic cholecystitis is gallbladder inflammation that has lasted a long time. It almost always results from gallstones and from prior attacks of acute cholecystitis. Chronic cholecystitis is characterized by repeated attacks of pain (biliary colic) that occur when gallstones periodically block the cystic duct Of these 59 patients, 15 had chronic cholecystitis (documented by surgery in 7, ultrasound in 7, and oral cholecystography in 1) and 44 had only nonbiliamy disease. One patient with chronic cholecystitis also had active peptic ulcer disease and delayed gallbladder visualization, for a total of 45 patients with nonbiliary disease and negative scans