Chronic cholecystitis ultrasound: Difference between revisions

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==Overview==
==Overview==
[[Ultrasound|Sonography]] is a sensitive and specific modality for diagnosis of acute cholecystitis; adjusted sensitivity and specificity for diagnosis of acute cholecystitis are 88% and 80%, respectively. The 2 major diagnostic criteria are [[gallstone|cholelithiasis]] and sonographic [[Murphy's sign]]. Minor criteria includes gallbladder wall thickening greater than 3mm, pericholecystic fluid, and gallbladder dilatation. <ref name="Shea">Shea, JA, Berlin, JA, Escarce, JJ, et al. ''Revised estimates of diagnostic test sensitivity and specificity in suspected biliary tract disease''. Arch Intern Med 1994; 154:2573.</ref> <ref name="Fink">Fink-Bennett, D, Freitas, JE, Ripley, SD, Bree, RL. ''The sensitivity of hepatobiliary imaging and real time ultrasonography in the detection of acute cholecystitis''. Arch Surg 1985; 120:904.</ref>
[[Ultrasound|Sonography]] is the most effective initial modality for the diagnosis of chronic cholecystitis. The 2 major diagnostic criteria are [[gallstone|cholelithiasis]] and sonographic [[Murphy's sign]]. Other findings may include [[gallbladder wall thickening]], and gallbladder dilatation or contraction.  
 
==Ultrasound==
==Ultrasound==
Abdominal ultrasound is the most effective initial modality for the diagnosis of chronic cholecystitis.<ref name="Shea">Shea, JA, Berlin, JA, Escarce, JJ, et al. ''Revised estimates of diagnostic test sensitivity and specificity in suspected biliary tract disease''. Arch Intern Med 1994; 154:2573.</ref>
*The 2 major diagnostic criteria are:
**[[Cholelithiasis]]
**Sonographic [[Murphy's sign]]
*Other findings may include:
**[[Gallbladder wall thickening]]
**Gallbladder dilatation or contraction


* This is the first test to be done in any suspected cases of cholecystitis.
[[File:Chronic cholecystitits usg.jpg|400px|thumb|center|USG abdomen for chronic cholecystitis; white arrow shows '''gallblader wall thickening''' and intraluminal enhancement shows '''gallstones'''. <small>Courtesy:Adriaan C. van Breda Vriesman et al. and radiologyassistant.nl <ref name="urlThe Radiology Assistant : Gallbladder - Wall Thickening">{{cite web |url=http://www.radiologyassistant.nl/en/p43a0746accc5d/gallbladder-wall-thickening.html#i43dfe33d61ae8 |title=The Radiology Assistant : Gallbladder - Wall Thickening |format= |work= |accessdate=}}</ref></small>]]
 
* Sonography is the fastest, most cost effective, and most accurate  diagnostic modality.
 
* Sensitivity is reported to be as high as 90-95%.
 
===Calculous Cholecystitis===
* Acute calculous cholecystitis is diagnosed radiologically by the presence of
** Thickening of gallbladder (5mm or greater)
** Pericholecystic fluid
** Probe tenderness (ultrasonographic Murphy's sign)
 
===Acalculous Cholecystitis===
The ultrsound based diagnostic criteria from multiple studies for acalculous cholecystits is as follows.<ref name="Huffman-2010">{{Cite journal  | last1 = Huffman | first1 = JL. | last2 = Schenker | first2 = S. | title = Acute acalculous cholecystitis: a review. | journal = Clin Gastroenterol Hepatol | volume = 8 | issue = 1 | pages = 15-22 | month = Jan | year = 2010 | doi = 10.1016/j.cgh.2009.08.034 | PMID = 19747982 }}</ref>
{|class="wikitable"
! Criteria!! Diagnosis
|-
| Major || 3.5 to 4 mm (or more) thick wall (if at least 5 cm distended longitudinally with no ascites or hypoalbuminemia)<br>Pericholecystic fluid (halo)/subserosal edema<br>Intramural gas<br>Sloughed mucosal membrane
|-
| Minor|| Echogenic bile (sludge)<br>Hydrops = distension greater than 8-cm longitudinally or 5-cm transversely (with clear fluid)
|-
|}
 
'''Diagnosis:''' 2 major or 1 major and 2 minor (most studies have favored the diagnostic triad: wall thickness, sludge, hydrops).
 
===Chronic Calculous and Acalculous Cholecystitis===
Ultrasound features of chronic cholecystitis can be non specific. Cholelithiasis with contracted or distended but thickened gallbladder and without any pericholecystic inflammation can be the findings.<ref name="Yun-">{{Cite journal  | last1 = Yun | first1 = EJ. | last2 = Cho | first2 = SG. | last3 = Park | first3 = S. | last4 = Park | first4 = SW. | last5 = Kim | first5 = WH. | last6 = Kim | first6 = HJ. | last7 = Suh | first7 = CH. | title = Gallbladder carcinoma and chronic cholecystitis: differentiation with two-phase spiral CT. | journal = Abdom Imaging | volume = 29 | issue = 1 | pages = 102-8 | month =  | year =  | doi = 10.1007/s00261-003-0080-4 | PMID = 15160762 }}</ref>


==References==
==References==

Latest revision as of 19:55, 21 February 2018

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Furqan M M. M.B.B.S[2]

Overview

Sonography is the most effective initial modality for the diagnosis of chronic cholecystitis. The 2 major diagnostic criteria are cholelithiasis and sonographic Murphy's sign. Other findings may include gallbladder wall thickening, and gallbladder dilatation or contraction.

Ultrasound

Abdominal ultrasound is the most effective initial modality for the diagnosis of chronic cholecystitis.[1]

USG abdomen for chronic cholecystitis; white arrow shows gallblader wall thickening and intraluminal enhancement shows gallstones. Courtesy:Adriaan C. van Breda Vriesman et al. and radiologyassistant.nl [2]

References

  1. ↑ Shea, JA, Berlin, JA, Escarce, JJ, et al. Revised estimates of diagnostic test sensitivity and specificity in suspected biliary tract disease. Arch Intern Med 1994; 154:2573.
  2. ↑ "The Radiology Assistant : Gallbladder - Wall Thickening".


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