59 yr old diabetic man with a 3 day h/o right upper quadrant pain and vomiting. An abdominal USG shows thickening of the gb wall and pericholecystic fluid but no gallstones. The pt deteriorates clinically and repeat usg shows bright echogenic area in gb fundus with acoustic shadowing. What is the likely diagnosis ?
A) adenomyomatosis
B ) emphysematous cholecystitis
C) gallbladder Ca
D) porcelain gallbladder
Likely it is acute acalculous cholecystitis with sludge ( giving appearance of bright echogenic collection in GB fundus) but no mention of gas is there (also because USG is poor in detecting gas) . Still there’s high chance of developing Emphysematous cholecystitis in setting of acute acalculous cholecystitis
Even porcelain GB can show echogenic boundary with acoustic shadowing due to calcification but don’t know why it was missed in 1st USG ; can be associated with Acalculous cholecystitis so ans can be either (b) or (d) . Better confirm with Rohan Khandelwal sir once