Right upper quadrant pain, with fever and Murphy's sign clinically.
The gall bladder contains numerous small calculi in the neck, and there is echogenic debris within the gall bladder; this is dependent but not layering smoothly.
The patient has sonographic Murphy's sign.
The gall bladder wall measures 3mm (upper limit of normal) and there is no pericholecystic fluid.
Ultrasound findings of cholecystitis include:
Gall stones (unless it is acalculous)
Thickening of the gall bladder wall (>3mm) often with associated hyperaemia
Sonographic Murphy's sign
There may be purulent debris within the gall bladder that can include sloughed gall bladder mucosa
Gas in an inflammed gall bladder infers emphysematous cholecystitis - infection with a gas forming organism
This case is difficult; whilst the patient had a typical history, raised inflammatory markers and some of the signs of cholecystitis gall bladder wall thickness and pericholecystic fluid were not present.
He was treated for cholecystitis and improved, later having his gall bladder removed.