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Figure 1a. Acute acalculous cholecystitis associated with adenomyomatosis in a 54-year-old man with right upper quadrant pain and a high fever. MR imaging was performed because the patient presented with severe symptoms and US and CT findings were inconclusive. (a, b) Image from single-section MR cholangiopancre-atography (a) and coronal heavily T2-weighted image (b) show a distended gallbladder with an enlarged Rokitansky-Aschoff sinus (arrow) at the gallbladder neck. (c) Axial heavily T2-weighted image shows diffuse hypointense thickening of the gallbladder wall (open arrows). There is some purulent bile (solid arrow), which like a sludge forms a lower layer and is hypointense relative to normal bile. Note the small amount of ascites around the liver (arrowhead). (d) Axial fat-suppressed T2-weighted image shows diffuse hyperintense thickening of the gallbladder wall (open arrows), a finding indicative of acute inflammation. It is difficult to identify the purulent bile on this image. Note the small amount of ascites around the liver (arrowhead).
