Chronic cholecystitis CT: Difference between revisions

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{{CMG}}
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{{CMG}}; {{AE}} {{ADI}}, {{MMF}}
{{Cholecystitis}}
{{Cholecystitis}}


==Overview==
==Overview==
The reported sensitivity and specificity of [[computed axial tomography|CT scan]] findings are in the range of 90-95%. CT is more sensitive than ultrasonography in the depiction of pericholecystic inflammatory response and in localizing pericholecystic abscesses, pericholecystic gas, and [[calculus (medicine)|calculi]] outside the [[lumen]] of the gallbladder.
CT scan findings associated with chronic cholecystitis include [[gallbladder wall thickening]], [[gallbladder]] distension or contraction and subserosal edema.


==CT Scan==
==CT scan==
* CT scan is more specific than ultrasound.
* CT scan is more specific than ultrasound. CT scan findings include:<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><ref name="pmid8615248">{{cite journal |author=Fidler J, Paulson EK, Layfield L |title=CT evaluation of acute cholecystitis: findings and usefulness in diagnosis |journal=[[AJR. American Journal of Roentgenology]] |volume=166 |issue=5 |pages=1085–8 |year=1996 |month=May |pmid=8615248 |doi= |url=http://www.ajronline.org/cgi/pmidlookup?view=long&pmid=8615248 |accessdate=2012-08-20}}</ref><ref name="urlCross-Sectional Imaging of Acute and Chronic Gallbladder Inflammatory Disease : American Journal of Roentgenology : Vol. 192, No. 1 (AJR)">{{cite web |url=https://www.ajronline.org/doi/abs/10.2214/AJR.07.3803 |title=Cross-Sectional Imaging of Acute and Chronic Gallbladder Inflammatory Disease : American Journal of Roentgenology : Vol. 192, No. 1 (AJR) |format= |work= |accessdate=}}</ref><ref name="pmid23541278">{{cite journal |vauthors=Kaura SH, Haghighi M, Matza BW, Hajdu CH, Rosenkrantz AB |title=Comparison of CT and MRI findings in the differentiation of acute from chronic cholecystitis |journal=Clin Imaging |volume=37 |issue=4 |pages=687–91 |year=2013 |pmid=23541278 |doi=10.1016/j.clinimag.2013.02.009 |url=}}</ref>
* CT scan findings include
** [[Gallbladder wall thickening]]
** Gall bladder distension
** [[Gallbladder]] distension or contraction
** Gall bladder thickening
** Pericholecystic fat density
** Pericholecystic fluid collection
** Subserosal edema
** Subserosal edema
** High attenuation gallbladder bile
** High attenuation gallbladder bile
* CT cannot identify noncalcified gallbladder calculi and cannot assess for [[Murphy's sign]].<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>


CT cannot see noncalcified gallbladder calculi, and cannot assess for a Murphy's sign. <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>
===Acalculous Cholecystitis===
The CT 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 to 4 mm wall thickness<br>Pericholecystic fluid<br>Subserosal edema<br>Intramural gas<br>Sloughed mucosa
|-
| Minor|| Hyperdense bile (sludge)<br>Subjective distension (hydrops)
|-
|}


'''Patient #1: CT demonstrates findings that are consistent with acute cholecystitis (gallstone in GB neck, perichol fluid, GB wall thickening)'''
'''Diagnosis:''' The diagnosis requires 2 major or 1 major and 2 minor to be positive.
<gallery>
Image:


Acute cholecystitis 001.jpg
==References==
 
{{reflist|2}}
Image:


Acute cholecystitis 002.jpg
[[Category:Gastroenterology]]
[[Category:Hepatology]]
[[Category:Surgery]]
[[Category:Emergency medicine]]


</gallery>


==References==
{{WH}}
{{Reflist|2}}
{{WS}}

Latest revision as of 19:53, 21 February 2018


Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Aditya Govindavarjhulla, M.B.B.S. [2], Furqan M M. M.B.B.S[3]

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Overview

CT scan findings associated with chronic cholecystitis include gallbladder wall thickening, gallbladder distension or contraction and subserosal edema.

CT scan

Acalculous Cholecystitis

The CT based diagnostic criteria from multiple studies for acalculous cholecystits is as follows:[7]

Criteria Diagnosis
Major 3 to 4 mm wall thickness
Pericholecystic fluid
Subserosal edema
Intramural gas
Sloughed mucosa
Minor Hyperdense bile (sludge)
Subjective distension (hydrops)

Diagnosis: The diagnosis requires 2 major or 1 major and 2 minor to be positive.

References

  1. ↑ Yun, EJ.; Cho, SG.; Park, S.; Park, SW.; Kim, WH.; Kim, HJ.; Suh, CH. "Gallbladder carcinoma and chronic cholecystitis: differentiation with two-phase spiral CT". Abdom Imaging. 29 (1): 102–8. doi:10.1007/s00261-003-0080-4. PMID 15160762.
  2. ↑ Fidler J, Paulson EK, Layfield L (1996). "CT evaluation of acute cholecystitis: findings and usefulness in diagnosis". AJR. American Journal of Roentgenology. 166 (5): 1085–8. PMID 8615248. Retrieved 2012-08-20. Unknown parameter |month= ignored (help)
  3. ↑ "Cross-Sectional Imaging of Acute and Chronic Gallbladder Inflammatory Disease : American Journal of Roentgenology : Vol. 192, No. 1 (AJR)".
  4. ↑ Kaura SH, Haghighi M, Matza BW, Hajdu CH, Rosenkrantz AB (2013). "Comparison of CT and MRI findings in the differentiation of acute from chronic cholecystitis". Clin Imaging. 37 (4): 687–91. doi:10.1016/j.clinimag.2013.02.009. PMID 23541278.
  5. ↑ 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.
  6. ↑ 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.
  7. ↑ 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)


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