Chronic cholecystitis CT: Difference between revisions
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==CT== | ==CT== | ||
* CT scan is more specific than ultrasound. | * CT scan is more specific than ultrasound. | ||
===Calculous Cholecystitis=== | |||
* CT scan findings include<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> | * CT scan findings include<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> | ||
** Gallbladder wall thickening | ** Gallbladder wall thickening | ||
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* CT cannot see 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 [[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 Demonstrates Findings that are Consistent with Acute Cholecystitis (Gallstone in GB Neck, Pericholicystic Fluid and GB Wall Thickening)=== | ====CT Demonstrates Findings that are Consistent with Acute Cholecystitis (Gallstone in GB Neck, Pericholicystic Fluid and GB Wall Thickening)==== | ||
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=== | ===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> | 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> | ||
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'''Diagnosis:''' 2 major or 1 major and 2 minor | '''Diagnosis:''' 2 major or 1 major and 2 minor | ||
===Chronic Calculous and Acalculous Cholecystitis=== | |||
CT 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== | ||
Revision as of 16:47, 9 January 2014
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Aditya Govindavarjhulla, M.B.B.S. [2]
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Chronic cholecystitis Microchapters |
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Chronic cholecystitis CT On the Web |
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American Roentgen Ray Society Images of Chronic cholecystitis CT |
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Risk calculators and risk factors for Chronic cholecystitis CT |
Overview
The reported sensitivity and specificity of 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 calculi outside the lumen of the gallbladder.
CT
- CT scan is more specific than ultrasound.
Calculous Cholecystitis
- CT scan findings include[1]
- Gallbladder wall thickening
- Gallbladder distension
- Pericholecystic fat density
- Pericholecystic fluid collection
- Subserosal edema
- High attenuation gallbladder bile
- CT cannot see noncalcified gallbladder calculi, and cannot assess for Murphy's sign. [2] [3]
CT Demonstrates Findings that are Consistent with Acute Cholecystitis (Gallstone in GB Neck, Pericholicystic Fluid and GB Wall Thickening)
Acalculous Cholecystitis
The CT based diagnostic criteria from multiple studies for acalculous cholecystits is as follows.[4]
| 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: 2 major or 1 major and 2 minor
Chronic Calculous and Acalculous Cholecystitis
CT 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.[5]
References
- ↑ 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) - ↑ 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
|month=ignored (help) - ↑ 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.