Case 1

Two different patients:

The first (image 1a) patient is a 61 year old man who is post heart transplant who presented with fever, an elevated white blood cell count, nausea and vomiting.

The second (image 1b) patient is a 56 year old man with diabetes and a history of multiple strokes who was transferred from an outside hospital obtunded and with an elevated white blood cell count.

Images of the gallbladder are as follows:

Figure 1a: Grey scale image of the gallbladder shows a very distended gallbladder filled with sludge and multiple small stones (not well seen on this image). There is a defect in the gallbladder wall with a large complex irregularly-shaped fluid collection adjacent to the gallbladder along the hepatic surface consistent with an abscess and due to perforation. No sonographic Murphy sign was elicited.

Figure 1b: Grey scale image shows a distended gallbladder with a very thinned, irregular wall at the level of the fundus with an adjacent large, focal fluid collection as described in figure 1a.

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