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Air In and Around the Gallbladder

The Common Vein Copyright 2008

Causes of air in and around the gallbladder ranges from benign accumulation in gallstones to severe emphysematous cholecytitis.   Air in the wall is always abnormal, but air in the lumen needs careful clinical input since it may be benign or underlie severe disease.

Emphysematous cholesystitis is a severe anerobic infection of the gallbladder most commonly seen in diabetic patients.  The air can accumulate in the wall or may accumulate in the lumen.  Other pathological causes include trauma and gallstone ileus. Rare causes include liver abscess and cholangitis.  Air in the biliary tree and gallbladder is commonly seen post ERCP.

 Diagnosis requires imaging and although plain film can make the diagnosis, CT is the more senstive to small amounts of air.  Ultrasound can be helpful but air usually shadows to the extent that it may be difficult to definitively identify.

 Treatment for emphysematous cholecystitis is emergency surgery.

 

Emphysematous Cholecystitis
82384.6ks 78M air in gallbladder wall abdominal pain emphysematous cholecystitis CTscan copyright 2008 Courtesy Ashley Davidoff MD

Emphysematous Cholecystitis Air in Lumen and Wall
16195c01.8s elderly patient with heart disease and significant atherosclerotic disease gallbladder lumen is filled with air wall linear air collection bubbles of air air fluid level dx emphysematous cholecystitis CTscan Courtesy Ashley Davidoff MD copyright 2008

Emphysematous Cholecystitis Air in Lumen and Wall  – Plain Film
04537c02s air in the gallbladder wall air in the lumen dx emphysematous cholecystitis gallbladder wall lumen plain X-ray lateral abdominal projection Courtesy Ashley DAvidoff MD copyright 2008

Emphysematous Cholecystitis Air in Lumen Air Fluid Level

Air in Wall
04541c01s air in the gallbladder wall air in the lumen air fluid level dx emphysematous cholecystitis gallbladder wall lumen plain X-ray decubitus right side up lateral abdominal projection Courtesy Ashley DAvidoff MD copyright 2008

Bullet Wound – Emphysematous Cholecystitis Air in Wall
04641c01.8s gunshot wound to the abdomen gallbladder air in wall emphysematous cholecystitis fragments of bullet plain X-ray Courtesy Ashley Davidoff MD Copyright 2008

Cholecysto-duodenal Fistula
26909c04.8s gallbladder air stomach duodenum thickened dx penetrating ulcer dx cholecystoduodenal fistula IVC inferior vena cava filteer small prominent folds valvulae conniventes ascites CTscan C+ Courtesy Ashley Davidoff MD copyright 2008
Gallstone Ileus
31127c02.8s gallbladder stones air adherent to duodenum small bowel dilatation calcification stone gallstone ileus CTscan Courtesy Ashley DAvidoff copyright 2008
Iatrogenic Air
47221c01s gallbladder air cystic duct iatrogenic bile duct ERCP Courtesy Ashley Davidoff MD copyright 2008

Iatrogenic Air
22333 gallbladder + fx air + imaging radiology CTscan C- probably post ERCP
Bowel Ischemia and Air in the Gallbladder
16310c01.8 liver portal vein air gallbladder colon pneumatosis coli superior mesenteric vein SMV bowel ischemia ischemic bowel bowel infarction CTscan Courtesy Ashley DAvidoff MD copyright 2008

Iatrogenic Air
81901.8s gallbladder hemorrhagic cholecystitis cholecystostomy further hemorrhage air iatrogenic catheter CTscan Courtsesy Ashley Davidoff MD copyright 2008
Emphysematous Cholecystitis
31188a02 Courtesy Ashley Davidoff MD pancreas head body fx exudate dx acute pancreatitis imaging radiology CTscan inflammation gallbladder fx air post endoscopy

Floating and Gas Filled Stones
26540 gallbladder + fx filling defects + fx air + fx floating + dx cholelithiasis + imaging radiology CTscan C-
Subtle Character Changes MinimalAmount of Air in a Floating Stone
70269c02 gallbladder air methane nitrogen gas cholesterol stone isodense with bile fat subtle change CTscan

Reflux Through Incompetent Ampulla
82178c01.8s air gallbladder contracted small chronic cholecystitis left intrahepatic bile ducts nephrolithiasis CTscan Courtesy Ashley Davidoff MD copyright 2008

Reflux Through Stent
16311.8s gallbladder bile duct air fx air biliary stent dx reflux of air into the cystic duct and gallbladder CTscan Courtesy Ashley Davidoff MD copyright 2008
Abscess in the Gallbladder Fossa s/p Cholecystectomy
The CTscan represents an abscess in the post operative bed of a patient who had undergone cholecystectomy.  The post op fossa and abscess has  the same pyriform shape as the gallbladder and contains a fluid collection with bubbles of air characteristic of an infection with anerobic organisms.  the bubbles although floating to the top are not quite free to form an air fluid layer indicating complex fluid probably with thick pus and fibrinous strands.  Percutaneous drainage is indicated.

of a different type 77668.8s gallbladder gallbladder fossa s/p cholecystectomy skin bile duct stent air fluid air fluid level s/p cholecystectomy abscess in post operative bed CTscan Courtesy Ashley DAvidoff MD copyright 2008

Gallbladder Perforation and pericholecystic abscess
16254c01b02.8s gallbladder thickened irregular wall air anterior wall small fluid collection gallbladder carcinoma complicated by perforation and abscess formation CTscan Courtesy Ashley Davidoff copyright 2008

Gelfoam Packing
46625 gallbladder fossa s/p cholecystectomy with gelfoam packing of fossa fx echgenic collection in gallbladder fossa dx air within gelfoam USscan Davidoff MD

Reference:

Radswiki: pneumobilia

Reference: Reuter: Der Groe Reuter. Springer Universalworterbuch Medizin, Pharmakologie Und