Fig. 2
From: Role of MSCT in the diagnosis of perforated gall bladder (a retrospective study)
56-year-old male has DM, HTN, and IHD presented with acute abdominal pain especially over RUQ associated with spikes of fever. a Admission US shows relative GB distension with biliary mud (bile-mud level). There were no stones or pericholecystic fluid. The patient did not improve on conservative treatment and pain was increasing. 40 h later, CT scan done, axial (b, c) and 2D sagittal reformat (d) shows lack of enhancement of GB wall, pericholecystic fluid collection, and inflammatory changes in juxtaposed hepatic flexure of colon. GB wall was not clearly identified at the fundus (arrow in d). Laparoscopic cholecystectomy revealed a gangrenous GB filled with pus (acute non-calcular empyema and gangrenous GB)