A 60 years old lady, B. Asthma from 25 years on inhalers, C/o pain epigastrium 15 days, anorexia, on investigations TLC 12600, blood sugar 216 random, 180 mg fasting, S. TSH 5.8 nng.

Hb 9.2 gm%, Not responding to PPI, no OHA prescribed as she is lean and thin lost four kg of body weight, USG abdomen shows radiolucent round shadow in gall bladder. Is it the emphysematous infection, or thick fat ball or small stone?