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Fig. 4B. —50-year-old woman with gallbladder empyema. Intraluminal echoes with sonic shadow (calipers) in gallbladder fundus and infundibulum represent gallbladder stones. Longitudinal right upper abdomen section reveals thickened gallbladder wall with regions of increased thickness or nodularity (curved arrow) towards fundus. Note thin fluid film (short arrow) between liver surface and wall. Also note zone of increased echogenicity (long arrow) in dependent part of gallbladder with fluid level representing pus in empyema. Fluid is inhomogeneous, unlike sludge; however, no evidence of gas inclusions exists.

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