Article Text

Download PDFPDF
Acalculous cholecystitis with gallbladder necrosis in a patient presenting without abdominal pain
  1. Ellery Altshuler and
  2. Robert Case
  1. Department of Internal Medicine, University of Florida College of Meicine, Gainesville, Florida, USA
  1. Correspondence to Dr Ellery Altshuler; ElleryAltshuler{at}


An 83-year-old man with a history of chronic myelogenous leukaemia in remission maintained with bosutinib presented with new-onset fevers. He denied pain and had no other focal symptoms. Ultrasound imaging revealed mild gallbladder wall thickening. Non-contrasted CT revealed right upper quadrant inflammation of indeterminate source. The diagnosis of acalculous cholecystitis was made on the third day when a CT with oral contrast demonstrated a remarkably inflamed biliary tree. The gallbladder was surgically removed and found to be necrotic. The case highlights an unusual presentation for a well-known condition. Both ultrasound and CT have limited diagnostic sensitivity for acalculous cystitis. This case adds to existing literature to support development of acalculous cholecystitis in non-critically ill patients. Clinicians should maintain awareness of this condition among patients presenting to the hospital or clinic with abdominal pain. Careful discussion with radiology and surgery is indicated to guide diagnostic testing when initial imaging results are indeterminate.

  • drugs: gastrointestinal system
  • liver disease
  • chemotherapy
  • drug interactions

Statistics from


  • Contributors RC conceived of the idea for the case report and was the primary treating physician. EA did most of the research and wrote the majority of the report, though Robert Case contributed significantly.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Obtained.

  • Provenance and peer review Not commissioned; externally peer reviewed.

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.