Pus in the gallbladder with diffuse internal echoes that do not layer or shadow is most consistent with which complication?

Pus in the gallbladder with diffuse internal echoes that do not layer or shadow is most consistent with which complication?

• A. Emphysematous cholecystitis
• B. Empyema
• C. Porcelain gallbladder
• D. Membranous Gangrene Cholecystitis

Answer: (B)

Pus filling the gallbladder shows up on ultrasound as thick, echogenic material that uniformly occupies the lumen with little or no layering and without posterior shadowing. This appearance reflects purulent debris (empyema) rather than sludge, gas, or calcified wall. Emphysematous cholecystitis would reveal gas within the lumen or wall with reverberation artifacts; porcelain gallbladder presents as a bright, calcified gallbladder wall with posterior shadowing; membranous gangrene cholecystitis may show internal membranes or slough but not diffuse, nonshadowing purulent content.

Pus filling the gallbladder shows up on ultrasound as thick, echogenic material that uniformly occupies the lumen with little or no layering and without posterior shadowing. This appearance reflects purulent debris (empyema) rather than sludge, gas, or calcified wall. Emphysematous cholecystitis would reveal gas within the lumen or wall with reverberation artifacts; porcelain gallbladder presents as a bright, calcified gallbladder wall with posterior shadowing; membranous gangrene cholecystitis may show internal membranes or slough but not diffuse, nonshadowing purulent content.