Air where it shouldn’t be! Incidental diagnosis of emphysematous cholecystitis

Abstract

Emphysematous cholecystitis (EC) is a rare, potentially fatal variant of acute cholecystitis, caused by gas-forming organisms in the gallbladder wall. It most commonly affects elderly, diabetic, or immunocompromised patients, and can progress rapidly to perforation, sepsis, or death if not recognized early. A 71-year-old male was referred to our pulmonology department for exacerbation of chronic lung disease. Laboratory workup showed elevated C-reactive protein levels. A non-enhanced and contrast-enhanced multidetector computed tomography (MDCT) scan of the thorax revealed no acute pulmonary pathology, but proximal abdominal cuts incidentally demonstrated air inclusions within the gallbladder wall, highly suggestive of EC. The finding prompted further evaluation for anaerobic infection and consideration of urgent management. EC is typically associated with gallstones, vascular compromise, or systemic conditions such as diabetes, but may also occur in their absence. This case highlights the role of cross-sectional imaging in detecting unsuspected abdominal pathology and underlines the importance of carefully reviewing all structures visible on a scan, even when outside the primary area of interest Incidental recognition of EC can be life-saving, as timely diagnosis allows for early intervention and reduced risk of complications. For medical residents and junior clinicians, awareness of its radiologic appearance and risk factors is essential to ensure prompt, effective management.