Case submitted by Saeed Rad, M.D., radiologist, to 

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 This patient with diabetes, relatively minimal right upper quadrant pain, but also with signs of sepsis presented to the emergency room. Based upon CT imaging, the patient was diagnosed with emphysematous cholecystitis.

 Emphysematous cholecystitis is an uncommon type of acute cholecystitis. The gallbladder wall breaks down due to necrosis, resulting in foci of gas formation in the lumen and wall. Emphysematous cholecystitis is a surgical emergency due to the high risk of mortality from gallbladder perforation. 

Look for the presence of a pneumoperitoneum as this may indicate perforation.

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Can you diagnose this patient with pain and sepsis?

Image IQ Quiz: Patient Presents with Pain and Sepsis