Acute cholecystitis echocardiography and ultrasound: Difference between revisions

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Latest revision as of 16:00, 5 February 2018

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

Transabdominal ultrasound is the initial test of choice for the diagnosis of acute cholecystitis. Findings on an ultrasound diagnostic of acute cholecystitis include thickened gallbladder, gallstones or sludge, and pericholecystic fluid.

Ultrasound

Transabdominal ultrasonography is the initial test of choice for the diagnosis of acute cholecystitis and gallstones.^[1]^[2]^[3]^[4]^[5]
- Findings on an transabdominal ultrasonography diagnostic of acute cholecystitis include:
  - Thickened gallbladder (>4 mm)
  - Gallstones or sludge
  - Pericholecystic fluid
- Acalculous cholecystitis may only show a distended gallbladder

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.^[6]

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).

Advantages of ultrasound

Advantages of ultrasound include:
- Noninvasive
- Quick and readily available
- Relatively inexpensive

Limitations of ultrasound

Limitations of ultrasound include:
- Poor visualization with intraluminal gas between probe and gallbladder

USG of acute cholecystitis; Red arrow shows gallstone and yellow arrow shows gallblader wall thickening. Case courtesy of Dr Maulik S Patel, Radiopaedia.org, rID: 20542 Source:^[7]

References

↑ "Gallbladder, Cholecystitis, Acute - StatPearls - NCBI Bookshelf".
↑ Foard DE, Haber AH (1970). "Physiologically normal senescence in seedlings grown without cell division after massive gamma-irradiation of seeds". Radiat. Res. 42 (2): 372–80. PMID 5442405.
↑ Knab LM, Boller AM, Mahvi DM (2014). "Cholecystitis". Surg. Clin. North Am. 94 (2): 455–70. doi:10.1016/j.suc.2014.01.005. PMID 24679431.
↑ Gomes CA, Junior CS, Di Saverio S, Sartelli M, Kelly MD, Gomes CC, Gomes FC, Corrêa LD, Alves CB, Guimarães SF (2017). "Acute calculous cholecystitis: Review of current best practices". World J Gastrointest Surg. 9 (5): 118–126. doi:10.4240/wjgs.v9.i5.118. PMC 5442405. PMID 28603584.
↑ "Imaging of Cholecystitis : American Journal of Roentgenology : Vol. 196, No. 4 (AJR)".
↑ 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 |month= ignored (help)
↑ "Acute cholecystitis | Radiology Reference Article | Radiopaedia.org".

[urlGallbladder,_Cholecystitis,_Acute_-_StatPearls_-_NCBI_Bookshelf-1] "Gallbladder, Cholecystitis, Acute - StatPearls - NCBI Bookshelf".

[pmid5442405-2] Foard DE, Haber AH (1970). "Physiologically normal senescence in seedlings grown without cell division after massive gamma-irradiation of seeds". Radiat. Res. 42 (2): 372–80. PMID 5442405.

[pmid24679431-3] Knab LM, Boller AM, Mahvi DM (2014). "Cholecystitis". Surg. Clin. North Am. 94 (2): 455–70. doi:10.1016/j.suc.2014.01.005. PMID 24679431.

[pmid28603584-4] Gomes CA, Junior CS, Di Saverio S, Sartelli M, Kelly MD, Gomes CC, Gomes FC, Corrêa LD, Alves CB, Guimarães SF (2017). "Acute calculous cholecystitis: Review of current best practices". World J Gastrointest Surg. 9 (5): 118–126. doi:10.4240/wjgs.v9.i5.118. PMC 5442405. PMID 28603584.

[urlImaging_of_Cholecystitis_:_American_Journal_of_Roentgenology_:_Vol._196,_No._4_(AJR)-5] "Imaging of Cholecystitis : American Journal of Roentgenology : Vol. 196, No. 4 (AJR)".

[Huffman-2010-6] 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 |month= ignored (help)

[urlAcute_cholecystitis_|_Radiology_Reference_Article_|_Radiopaedia.org-7] "Acute cholecystitis | Radiology Reference Article | Radiopaedia.org".

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@@ Line 5: / Line 5: @@
 ==Overview==
-Ultrasound may be helpful in the diagnosis of acute cholecystitis. Findings on an ultrasound diagnostic of acute cholecystitis include thickened gallbladder, gallstones or sludge, and pericholecystic fluid.
+Transabdominal [[ultrasound]] is the '''initial test of choice''' for the diagnosis of acute cholecystitis. Findings on an ultrasound diagnostic of acute cholecystitis include [[Gallbladder wall thickening|thickened gallbladder]], [[gallstones]] or sludge, and pericholecystic fluid.
 ==Ultrasound==
-* Transabdominal ultrasonography is the gold standard for the diagnosis of gallstones.<ref name="urlGallbladder, Cholecystitis, Acute - StatPearls - NCBI Bookshelf">{{cite web |url=https://www.ncbi.nlm.nih.gov/books/NBK459171/#article-19448.s5 |title=Gallbladder, Cholecystitis, Acute - StatPearls - NCBI Bookshelf |format= |work= |accessdate=}}</ref><ref name="pmid5442405">{{cite journal |vauthors=Foard DE, Haber AH |title=Physiologically normal senescence in seedlings grown without cell division after massive gamma-irradiation of seeds |journal=Radiat. Res. |volume=42 |issue=2 |pages=372–80 |year=1970 |pmid=5442405 |doi= |url=}}</ref><ref name="pmid24679431">{{cite journal |vauthors=Knab LM, Boller AM, Mahvi DM |title=Cholecystitis |journal=Surg. Clin. North Am. |volume=94 |issue=2 |pages=455–70 |year=2014 |pmid=24679431 |doi=10.1016/j.suc.2014.01.005 |url=}}</ref><ref name="pmid28603584">{{cite journal |vauthors=Gomes CA, Junior CS, Di Saverio S, Sartelli M, Kelly MD, Gomes CC, Gomes FC, Corrêa LD, Alves CB, Guimarães SF |title=Acute calculous cholecystitis: Review of current best practices |journal=World J Gastrointest Surg |volume=9 |issue=5 |pages=118–126 |year=2017 |pmid=28603584 |pmc=5442405 |doi=10.4240/wjgs.v9.i5.118 |url=}}</ref>
+* Transabdominal [[ultrasonography]] is the initial test of choice for the diagnosis of acute cholecystitis and gallstones.<ref name="urlGallbladder, Cholecystitis, Acute - StatPearls - NCBI Bookshelf">{{cite web |url=https://www.ncbi.nlm.nih.gov/books/NBK459171/#article-19448.s5 |title=Gallbladder, Cholecystitis, Acute - StatPearls - NCBI Bookshelf |format= |work= |accessdate=}}</ref><ref name="pmid5442405">{{cite journal |vauthors=Foard DE, Haber AH |title=Physiologically normal senescence in seedlings grown without cell division after massive gamma-irradiation of seeds |journal=Radiat. Res. |volume=42 |issue=2 |pages=372–80 |year=1970 |pmid=5442405 |doi= |url=}}</ref><ref name="pmid24679431">{{cite journal |vauthors=Knab LM, Boller AM, Mahvi DM |title=Cholecystitis |journal=Surg. Clin. North Am. |volume=94 |issue=2 |pages=455–70 |year=2014 |pmid=24679431 |doi=10.1016/j.suc.2014.01.005 |url=}}</ref><ref name="pmid28603584">{{cite journal |vauthors=Gomes CA, Junior CS, Di Saverio S, Sartelli M, Kelly MD, Gomes CC, Gomes FC, Corrêa LD, Alves CB, Guimarães SF |title=Acute calculous cholecystitis: Review of current best practices |journal=World J Gastrointest Surg |volume=9 |issue=5 |pages=118–126 |year=2017 |pmid=28603584 |pmc=5442405 |doi=10.4240/wjgs.v9.i5.118 |url=}}</ref><ref name="urlImaging of Cholecystitis : American Journal of Roentgenology : Vol. 196, No. 4 (AJR)">{{cite web |url=http://www.ajronline.org/doi/full/10.2214/AJR.10.4340 |title=Imaging of Cholecystitis : American Journal of Roentgenology : Vol. 196, No. 4 (AJR) |format= |work= |accessdate=}}</ref>
 ** Findings on an transabdominal ultrasonography diagnostic of acute cholecystitis include:
-*** Thickened gallbladder (>4 mm)
+*** [[Gallbladder wall thickening|Thickened gallbladder]] (>4 mm)
-*** Gallstones or sludge
+*** [[Gallstones]] or sludge
 ***Pericholecystic fluid
+**Acalculous cholecystitis may only show a distended gallbladder
+===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).
+===Advantages of ultrasound===
+*Advantages of ultrasound include:
+**Noninvasive
+**Quick and readily available
+**Relatively inexpensive
+===Limitations of ultrasound===
+*Limitations of ultrasound include:
+**Poor visualization with intraluminal gas between probe and gallbladder
+[[File:USG acute cholecystitis.gif|900px|thumb|center|USG of acute cholecystitis; Red arrow shows gallstone and yellow arrow shows gallblader wall thickening. <small> Case courtesy of Dr Maulik S Patel, Radiopaedia.org, rID: 20542 Source:<ref name="urlAcute cholecystitis | Radiology Reference Article | Radiopaedia.org">{{cite web |url=https://radiopaedia.org/articles/acute-cholecystitis |title=Acute cholecystitis &#124; Radiology Reference Article &#124; Radiopaedia.org |format= |work= |accessdate=}}</ref>]]
 ==References==
 {{Reflist|2}}