ARDMS AB-Abdomen Dumps

A full bladder provides an acoustic window that displaces bowel gas and distends the bladder walls, allowing optimal visualization of any bladder masses or lesions. An empty bladder may collapse, obscuring masses.

According to Rumack’s Diagnostic Ultrasound:

“Bladder evaluation should be performed with the bladder optimally distended to visualize its walls and any intraluminal masses.”

The ultrasound image shows echogenic foci with dirty shadowing and reverberation artifacts within the gallbladder wall and lumen. These features are characteristic of emphysematous cholecystitis, a severe, life-threatening variant of acute cholecystitis caused by gas-forming organisms (e.g., Clostridium or E. coli) infecting the gallbladder wall.

Sonographic features of emphysematous cholecystitis:

Echogenic gas within the gallbladder wall or lumen

Reverberation or "dirty" shadowing artifacts

May show intramural gas bubbles or "ring-down" artifact

Often seen in diabetic or immunocompromised patients

No gallstones may be present ("acalculous cholecystitis")

Clinical context:

More common in elderly men and diabetics

Presents with right upper quadrant pain, fever, and leukocytosis

Surgical emergency due to risk of perforation and sepsis

Differentiation from other options:

A. Adenomyomatosis: Involves gallbladder wall thickening with “comet tail” artifacts due to Rokitansky-Aschoff sinuses, not intramural gas.

B. Porcelain gallbladder: Shows curvilinear calcification of the gallbladder wall — dense echogenic rim with posterior shadowing.

C. Gangrenous cholecystitis: May show wall irregularity, intraluminal membranes, and absence of Doppler flow but lacks intramural gas.

Exudative ascites is characterized by high protein content and cellular debris, typically resulting from infections (e.g., peritonitis, tuberculosis), malignancy, or inflammatory conditions. Transudative ascites is more commonly seen in conditions such as liver failure, renal failure, and hypoproteinemia due to changes in hydrostatic or oncotic pressure.

According to Light's Criteria:

“Infection and malignancy are common causes of exudative ascites, distinguished by high protein content and elevated LDH.”