Chronic cholecystitis ultrasound
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
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Overview
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 cholelithiasis and sonographic Murphy's sign. Minor criteria includes gallbladder wall thickening greater than 3mm, pericholecystic fluid, and gallbladder dilatation. [1] [2]
Ultrasound
- This is the first test to be done in any suspected cases of cholecystitis.
- Sonography is the fastest, most cost effective, and most accurate diagnostic modality.
- Sensitivity is reported to be as high as 90-95%.
- Acute calculous cholecystitis is diagnosed radiologically by the presence of
- Thickening of gallbladder (5mm or greater)
- Pericholecystic fluid
- Probe tenderness (ultrasonographic Murphy's sign)
Imaging Criteria for Acalculous Cholecystitis
The ultrsound based diagnostic criteria from multiple studies for acalculous cholecystits is as follows.[3]
Criteria | Diagnosis |
---|---|
Major | 3.5 to 4 mm (or more) thick wall (if at least 5 cm distended longitudinally with no ascites or hypoalbuminemia) Pericholecystic fluid (halo)/subserosal edema Intramural gas Sloughed mucosal membrane |
Minor | Echogenic bile (sludge) 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)
References
- ↑ 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.
- ↑ 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.
- ↑ Huffman, JL.; Schenker, S. (2010). "Acute acalculous cholecystitis: a review". Clin Gastroenterol Hepatol. 8 (1): 15–22. doi:10.1016/j.cgh.2009.08.034. PMID 19747982. Unknown parameter
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