Acute Calculous Cholecystitis





KEY FACTS


Terminology





  • Acute inflammation of gallbladder (GB) secondary to calculus obstructing cystic duct



Imaging





  • US 1st-line imaging test



  • Distended GB (> 5 cm transverse diameter) with rounded/ballooned shape



  • Gallstones ± impaction in GB neck or cystic duct



  • Diffuse GB wall thickening (> 4-5 mm)



  • Hazy delineation of GB wall with echogenic pericholecystic fat ± pericholecystic fluid



  • Positive sonographic Murphy sign: Pain and tenderness with transducer pressure directly over GB



  • Combination of gallstones, wall thickening, and positive Murphy sign increase specificity




    • Murphy sign may be negative after opioids or when gangrenous




  • Gangrenous cholecystitis : Asymmetric wall thickening, marked wall irregularities, intraluminal membranes



  • Gallbladder perforation : Defect in GB wall with pericholecystic abscess or extraluminal stones



  • Emphysematous cholecystitis : Gas in GB wall/lumen



Top Differential Diagnoses





  • Secondary GB wall thickening or adjacent inflammatory disease



Clinical Issues





  • Typically > 25 years; M:F = 1:3



  • Acute right upper quadrant pain, nausea, anorexia, vomiting, local tenderness to palpation



  • Increased WBC; mild elevation in liver enzymes



Scanning Tips





  • Move patient to look for impacted stone in neck/cystic duct, assess Murphy sign and surrounding area







Left lateral decubitus ultrasound shows a shadowing stone in the neck of the gallbladder (GB) . Note the thick wall with subserosal edema . Murphy sign was positive.








Longitudinal ultrasound in the left lateral decubitus position shows that the GB is distended. There is an impacted stone in the neck with a sludge level and increased echogenicity of the pericholecystic fat .








Longitudinal ultrasound in the left lateral decubitus position shows a distended GB with a bulging contour . Murphy sign was positive. There is sludge , but the wall was not thick. Small stones and acute cholecystitis were found at surgery.








Longitudinal oblique ultrasound shows gangrenous perforated cholecystitis with a shaggy wall and a focal collection at the fundus . The lumen is less distended once the wall has perforated.








Longitudinal color Doppler ultrasound in the left lateral decubitus position shows that the GB is distended with an impacted stone in the neck and sludge in the fundus . This was acute on chronic cholecystitis at surgery.

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Nov 10, 2024 | Posted by in ULTRASONOGRAPHY | Comments Off on Acute Calculous Cholecystitis

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