UMEM Educational Pearls


70 yo female from nursing home with fever. RUQ ultrasound is shown below. Diagnosis?


Acalculous Cholecystitis

Acalculous cholecystitis is due to gallbladder (GB) wall ischemia and GB stasis (reduced GB contraction from reduced PO intake)

which all leads to “sludging” (Figure 1; A), thickened GB walls (B), and pericholecystic fluid (C).


Risk factors include critical illness (especially sepsis), acute cholecystitis, total parenteral nutrition, diabetes, and GB dysmotility.


Treatment includes antibiotics covering enteric / biliary pathogens and cholecystectomy (if a surgical candidate) or percutaneous

cholecystostomy if unsuitable for the OR. 

Complications include perforation, GB gangrene, and extrabiliary abscess.