Ultrasonographic diagnosis of gangrenous cholecystitis and empyema of the gallbladder.

The ultrasonographic appearance of five cases of acute cholecystitis which progressed to either gangrenous necrosis or empyema of the gallbladder is presented with clinical, surgical and pathological correlation. A typical pattern consisted of diffuse, medium-to-coarse intraluminal echoes within the gallbladder which did not show layering or acoustical shadowing. Other findings, including thickening of the gallbladder wall and localized peritoneal fluid collections, are described. It is concluded that cholecystosonography can be of considerable value in the early diagnosis of these serious complications of acute cholecystitis.