case_images: PMC4531617_01
case_images: Abdominal ultrasonography on the 1st admission shows distended gallbladder with internal debris and sludge materials.
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case_images: On the 2nd day of admission, abdominal ultrasonography revealed echogenic sludge materials within the distended gallbladder with no gallstone (Figure 1).
case_images: Abdominal CT on the 1st admission shows diffuse thickening of gallbladder wall and about 2cm sized highly-attenuated materials (arrow).
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case_images: On the 3rd day of admission, abdominal CT scan showed diffuse thickening of the gallbladder wall, high attenuated materials with a diameter of 2 cm and focal inflammatory stricture at the level of the common hepatic duct (Figure 2).
case_images: ERCP shows diffuse segmentally dilated Lt. IHD and slightly narrowed distal CHD (arrow). There is no filling defect in CBD and GB was invisible.
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case_images: The gallbladder was not seen and no evidence of choledocholithiasis was present (Figure 3).
case_images: Endoscopy shows a round shallow ulcer base with blood oozing at the junction of the 1st and 2nd part of duodenum.
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case_images: The bleeding ceased after the injection of 1:1000 epinephrine (Figure 4).
case_images: Abdominal US shows eccentric wall-thickening of anterior wall of GB and there was echogenic mass filling the GB lumen. Air trapping in the anterior wall of GB and biliary tract is also seen.
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case_images: The abdominal ultrasonography taken on the 13th day of the 2nd admission has shown significantly thickened anterior wall of the gallbladder with echogenic mass (Figure 5).
case_images: GB biopsy findings. (A) Microscopy shows diffuse epithelial hyperplasia with partially high-grade dysplasia on GB neck (arrow) (H&E, x40). (B) Microscopy shows focal areas of carcinomatous change on GB neck (H&E, x100). (C) Microscopy shows acute nonspecific suppurative inflammation on GB fundus. (H&E, x40).
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case_images: The histologic finding was compatible with acute nonspecific suppurative inflammation, as most of the mucosae were detached with a partially high grade dysplastic change in the neck of gallbladder and focal superficial carcinomatous invasion into the muscle layers (Figure 6A, 6B, 6C).