Solution: The findings in this case include: thickened, irregular gallbladder wall seen best on the US with associated hyperechoic foci. On the CT, you see a focus of air in the GB fundus and hyperattenuating material within the GB itself. Patient went to surgery for concern of emphysematous cholecystitis and during surgery was noted to have not only a necrotic GB, but also active hemorrhage into the GB (likely the high attenuation material within the GB). The recovered after cholecystectomy with no long term sequelae. Important point here is to identify the presence of air in the GB wall, which in this setting, without intervention is very concerning for emphysematous, gangrenous cholecystitis.