Surgeons have been dependent mainly on the clinical findings in the diagnosis of the empyema of gallbladderrequiring a emergent surgical intervention. Ultrasonographic findings of empyema of gallbladder are similar tothose of acute cholecystitis, but several finding are more frequently seen in empyema than in acute cholecystitis.We reviewed the clinical and ultrasonographic pictures in 15 cases of surgically proven empyema of gallbladder.The results were as follows: 1. Empyema of GB shows relatively high frequency in male and elderly person, comparedwith acute cholecystitis. 2. Right upper abdominal pain with tenderness and leukocytosis are constant findings inempyema. 3. Ultrasonographic findings; (1) GB is distended in 80%. (2) GB wall is thickened all ill defined in80%. (3) Internal echo is seen in 93.3%-diffuse(53.3%), localized (20%) or layered(20%). (4) Gallstones arelocated in CBD causing dilatation proximally.