Diagnosis: Patient with diabetes, relatively minimal right upper quadrant pain, but with signs of sepsis presenting to the emergency room ultimately diagnosed with emphysematous cholecystitis.

Key Points: Emphysematous cholecystitis is an uncommon type of acute cholecystitis. The gallbladder wall breaks down due to necrosis resulting in foci of gas formation in the lumen and wall. Emphysematous cholecystitis is a surgical emergency. It is a surgical emergency, due to the high risk of mortality from gallbladder perforation. Look for the presence of a pneumoperitoneum as this may indicate perforation.

Submitted by Dr. Saeed Rad MD to radRounds Radiology Network