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Case of the Month

August 2008

Patient Data: 87 year old male

Clinical Info: Pain in the right upper abdomen, fever and positive infection parameters


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Longitudinal image of the gallbladder with a membranous structure


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Longitudinal image of the gallbladder with sludge and the same membranous structure


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Longitudinal image of the gallbladder with gallstones, sludge and the same membranous structure


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Detail of the membranous structure in the gallbladder The membranous structure in the gallbladder is the sloughed mucosa and is a sign of a membranous cholecystitis which is a form of gangrenous cholecystitis. This an emergency condition. It must be differentiated from other intraluminal structures such as roundworms which however are uncommon in western countries. Another condition where linear intraluminal structures are found is the multiseptated gallbladder. The multiseptated gallbladder is also rather uncommon and is usually asymptomatic. The following images show the features of a multiseptated gallbladder in an asymptomatic 24 year old patient.


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Longitudinal image of the gallbladder with multiple septations


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Longitudinal image of the same multiseptated gallbladder with thin septations

For more cases of a membranous or gangrenous cholecystitis see

References
Teefey SA, Baron RL, Radke HM, Bigler SA. Gangrenous cholecystitis: new observations on sonography.
J Ultrasound Med. 1991 Nov;10(11):603-6.

Nakazawa T, Ohara H, Sano H, Kobayashi S, Nomura T, Joh T, Itoh M. Multiseptate gallbladder: diagnostic value of MR cholangiography and ultrasonography.
Abdom Imaging. 2004 Nov-Dec;29(6):691-3.

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