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Case: Emphysematous Cholecystitis With Portal Venous Gas Air

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0:00

Okay, here we have another, um,

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abdominal CT scan with contrast.

0:05

As we come down, we can see that the

0:06

patient has a little pleural effusion

0:07

here, maybe not feeling the best today.

0:10

And as we come into the liver, you can see that in

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the right lobe of the liver, we have little branching

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areas of air within the liver that is very classic for

0:19

portal venous air within the periphery of the liver.

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So already we know this patient is a little

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sicker than the normal patient we're seeing,

0:25

and as we come down to the gallbladder, you

0:27

can see a large obstructing calcified stone

0:30

just wedged in there at the gallbladder neck.

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But also this gallbladder, we see a nice rim

0:35

of air within the wall in that antidependent

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or in that dependent portion of the wall,

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and air-fluid within the lumen as well.

0:42

So this is a beautiful appearance

0:44

of emphysematous cholecystitis.

0:47

Um, there's air within the wall.

0:49

There's a lot of thickening and distension of that

0:51

gallbladder as well. As we're coming down the patient's

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GI tract with that evidence of obstruction.

0:57

We're going to see some beautiful diverticulum

0:59

down here in the pelvis, but nothing

1:01

other than just the, um, impressive

1:05

emphysematous cholecystitis.

1:05

I'll show it to you on coronal more

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just to show off than anything else.

1:09

That's just rim of air within the

1:12

gallbladder wall itself trapped there.

1:15

Can't even float upwards.

1:16

So the laws of air are— that they

1:19

should always be antidependent.

1:21

And here we have air within the liver as well.

1:25

So this is a beautiful image

1:26

of emphysematous cholecystitis.

Report

Faculty

Laura L Avery, MD

Assistant Professor of Emergency Radiology Harvard Medical School

Massachusetts General Hosptial

Tags

Other Biliary

Infectious

Gastrointestinal (GI)

Gallbladder

Emergency

CT

Body