The gall bladder is distended with an air-fluid level. A halo of air is seen within the substance of the gall bladder wall with a focal area of wall interruption and extravasation of air into the adjacent hepatic parenchyma. There is associated peri-cholecystic collection and stranding of fat planes. Few air foci are noted within the hepatic biliary radicles consistent with pneumobilia. Scanned lung bases revealed bilateral pleural effusion with underlying consolidation.