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Gallbladder Hydrops and Empyema
Siva P. Raman, MD
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KEY FACTS

  • Terminology

    • Imaging

      • Pathology

        • Clinical Issues

          TERMINOLOGY

          • Synonyms

            • Hydrops: Mucocele
            • Empyema: Suppurative cholecystitis
          • Definitions

            • Hydrops: Distention of gallbladder (GB) with watery mucoid material in absence of any underlying GB infection
              • Most often on basis of chronic cystic duct obstruction or abnormal GB motility
              • Content is usually sterile without GB inflammation
            • Empyema: Pus-filled, inflamed, and distended GB secondary to acute cholecystitis with suppurative intraluminal infection

          IMAGING

          • General Features

            • Imaging Recommendations

              • CT Findings

                • MR Findings

                  • Ultrasonographic Findings

                    DIFFERENTIAL DIAGNOSIS

                      PATHOLOGY

                      • General Features

                        • Gross Pathologic & Surgical Features

                          • Microscopic Features

                            CLINICAL ISSUES

                            • Presentation

                              • Demographics

                                • Natural History & Prognosis

                                  • Treatment

                                    DIAGNOSTIC CHECKLIST

                                    • Consider

                                      Selected References

                                      1. Yellamaty V et al: Kawasaki disease presenting as hydrops of the gallbladder. Clin Pediatr (Phila). 59(4-5):486-9, 2020
                                      2. Amarnath S et al: Spontaneous perforation of an acalculous hydropic gallbladder in a diabetic patient with neuropathy: an underdiagnosed entity. Gastroenterology Res. 12(6):315-9, 2019
                                      3. Sun Q et al: Gallbladder hydrops associated with kawasaki disease: a case report and literature review. Clin Pediatr (Phila). 57(3):341-3, 2018
                                      4. Mathai SS et al: Gall bladder hydrops - a rare initial presentation of Kawasaki disease. Indian J Pediatr. 80(7):616-7, 2013
                                      5. Brook OR et al: Lessons learned from quality assurance: errors in the diagnosis of acute cholecystitis on ultrasound and CT. AJR Am J Roentgenol. 196(3):597-604, 2011
                                      6. Panico MR et al: Massive hydrops of the gallbladder mimicking a choledochal cyst. J Pediatr Surg. 46(5):1015-8, 2011
                                      7. Queiroz AB et al: Images in clinical medicine. Hydropic gallbladder. N Engl J Med. 364(20):e43, 2011
                                      8. Tongdee R et al: The value of MDCT scans in differentiation between benign and malignant gallbladder wall thickening. J Med Assoc Thai. 94(5):592-600, 2011
                                      9. Kawasaki F et al: Gallbladder edema in type 1 diabetic patient due to delayed-type insulin allergy. Intern Med. 48(17):1545-9, 2009
                                      10. Mahid SS et al: Meta-analysis of cholecystectomy in symptomatic patients with positive hepatobiliary iminodiacetic acid scan results without gallstones. Arch Surg. 144(2):180-7, 2009
                                      11. Gurusamy KS et al: Early versus delayed laparoscopic cholecystectomy for biliary colic. Cochrane Database Syst Rev. (4):CD007196, 2008
                                      12. Misiakos EP et al: Laparoscopic cholecystectomy after open cholecystostomy for gallbladder empyema: a case report. J Laparoendosc Adv Surg Tech A. 17(5):655-8, 2007
                                      13. Nguyen DQ et al: A fatal case of MRSA septicaemia and gallbladder empyema. Int J Surg. 2(2):120-1, 2004
                                      14. Agrawal S et al: Gallstones, from gallbladder to gut. Management options for diverse complications. Postgrad Med. 108(3):143-6, 149-53, 2000
                                      15. Tseng LJ et al: Palliative percutaneous transhepatic gallbladder drainage of gallbladder empyema before laparoscopic cholecystectomy. Hepatogastroenterology. 47(34):932-6, 2000
                                      16. Feretis CB et al: Endoscopic transpapillary drainage of gallbladder empyema. Gastrointest Endosc. 36(5):523-5, 1990
                                      17. Krogh J: Empyema of the gallbladder: a case with unusual presentation. Acta Chir Belg. 89(4):204-5, 1989
                                      18. Radder RW: Ultrasonically guided percutaneous catheter drainage for gallbladder empyema. Diagn Imaging. 49(6):330-3, 1980
                                      Related Anatomy
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                                      Related Differential Diagnoses
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                                      References
                                      Tables

                                      Tables

                                      KEY FACTS

                                      • Terminology

                                        • Imaging

                                          • Pathology

                                            • Clinical Issues

                                              TERMINOLOGY

                                              • Synonyms

                                                • Hydrops: Mucocele
                                                • Empyema: Suppurative cholecystitis
                                              • Definitions

                                                • Hydrops: Distention of gallbladder (GB) with watery mucoid material in absence of any underlying GB infection
                                                  • Most often on basis of chronic cystic duct obstruction or abnormal GB motility
                                                  • Content is usually sterile without GB inflammation
                                                • Empyema: Pus-filled, inflamed, and distended GB secondary to acute cholecystitis with suppurative intraluminal infection

                                              IMAGING

                                              • General Features

                                                • Imaging Recommendations

                                                  • CT Findings

                                                    • MR Findings

                                                      • Ultrasonographic Findings

                                                        DIFFERENTIAL DIAGNOSIS

                                                          PATHOLOGY

                                                          • General Features

                                                            • Gross Pathologic & Surgical Features

                                                              • Microscopic Features

                                                                CLINICAL ISSUES

                                                                • Presentation

                                                                  • Demographics

                                                                    • Natural History & Prognosis

                                                                      • Treatment

                                                                        DIAGNOSTIC CHECKLIST

                                                                        • Consider

                                                                          Selected References

                                                                          1. Yellamaty V et al: Kawasaki disease presenting as hydrops of the gallbladder. Clin Pediatr (Phila). 59(4-5):486-9, 2020
                                                                          2. Amarnath S et al: Spontaneous perforation of an acalculous hydropic gallbladder in a diabetic patient with neuropathy: an underdiagnosed entity. Gastroenterology Res. 12(6):315-9, 2019
                                                                          3. Sun Q et al: Gallbladder hydrops associated with kawasaki disease: a case report and literature review. Clin Pediatr (Phila). 57(3):341-3, 2018
                                                                          4. Mathai SS et al: Gall bladder hydrops - a rare initial presentation of Kawasaki disease. Indian J Pediatr. 80(7):616-7, 2013
                                                                          5. Brook OR et al: Lessons learned from quality assurance: errors in the diagnosis of acute cholecystitis on ultrasound and CT. AJR Am J Roentgenol. 196(3):597-604, 2011
                                                                          6. Panico MR et al: Massive hydrops of the gallbladder mimicking a choledochal cyst. J Pediatr Surg. 46(5):1015-8, 2011
                                                                          7. Queiroz AB et al: Images in clinical medicine. Hydropic gallbladder. N Engl J Med. 364(20):e43, 2011
                                                                          8. Tongdee R et al: The value of MDCT scans in differentiation between benign and malignant gallbladder wall thickening. J Med Assoc Thai. 94(5):592-600, 2011
                                                                          9. Kawasaki F et al: Gallbladder edema in type 1 diabetic patient due to delayed-type insulin allergy. Intern Med. 48(17):1545-9, 2009
                                                                          10. Mahid SS et al: Meta-analysis of cholecystectomy in symptomatic patients with positive hepatobiliary iminodiacetic acid scan results without gallstones. Arch Surg. 144(2):180-7, 2009
                                                                          11. Gurusamy KS et al: Early versus delayed laparoscopic cholecystectomy for biliary colic. Cochrane Database Syst Rev. (4):CD007196, 2008
                                                                          12. Misiakos EP et al: Laparoscopic cholecystectomy after open cholecystostomy for gallbladder empyema: a case report. J Laparoendosc Adv Surg Tech A. 17(5):655-8, 2007
                                                                          13. Nguyen DQ et al: A fatal case of MRSA septicaemia and gallbladder empyema. Int J Surg. 2(2):120-1, 2004
                                                                          14. Agrawal S et al: Gallstones, from gallbladder to gut. Management options for diverse complications. Postgrad Med. 108(3):143-6, 149-53, 2000
                                                                          15. Tseng LJ et al: Palliative percutaneous transhepatic gallbladder drainage of gallbladder empyema before laparoscopic cholecystectomy. Hepatogastroenterology. 47(34):932-6, 2000
                                                                          16. Feretis CB et al: Endoscopic transpapillary drainage of gallbladder empyema. Gastrointest Endosc. 36(5):523-5, 1990
                                                                          17. Krogh J: Empyema of the gallbladder: a case with unusual presentation. Acta Chir Belg. 89(4):204-5, 1989
                                                                          18. Radder RW: Ultrasonically guided percutaneous catheter drainage for gallbladder empyema. Diagn Imaging. 49(6):330-3, 1980