Acute cholecystitis diagnostic study of choice
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Furqan M M. M.B.B.S[2]
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Overview
Transabdominal ultrasonography is the initial study of choice for the diagnosis of acute cholecystitis. Thickened gallbladder, gallstones or sludge, and pericholecystic fluid are the findings associated with transabdominal ultrasound in patients with acute cholecystitis.
Diagnostic Study of Choice
Gold standard/Study of choice:
- Transabdominal ultrasonography is the initial study of choice for the diagnosis of acute cholecystitis and gallstones.[1][2][3][2][4]
- The following result of transabdominal ultrasonography is confirmatory of acute cholecystitis:
- Thickened gallbladder (>4 mm)
- Gallstones or sludge
- Pericholecystic fluid
- The ultrasound should be performed when:
- The patient presents with right upper quadrant pain, abdominal guarding, fever, and a positive Murphy's sign.
The comparison table for diagnostic studies of choice for acute cholecystitis
The table below summarizes the sensitivities and specificities of the diagnostic studies for acute cholecystitis.[5]
| Test | Sensitivity | Specificity |
|---|---|---|
| Transabdominal Ultrasound✔✔ | 81% | 83% |
| Cholescintigraphy(HIDA)✔ | 96% | 90% |
| MRI | 85% | 81% |
✔= The best test based on the sensitivity and specificity ✔✔=Gold standard
Sequence of Diagnostic Studies
There is no specific sequence of the diagnostic studies for acute cholecystitis.[3][2]
- The transabdominal ultrasonography should be performed when:
- The patient presents with right upper quadrant pain, abdominal guarding, fever, and a positive Murphy's sign.
- A positive transabdominal ultrasonography is detected in the patient, to confirm the diagnosis.
- Cholescintigraphy (HIDA scan) is the gold standard in the diagnosis of acute cholecystitis. HIDA scan is an alternative method of imaging and uses technetium-labeled hepatic 2,6-dimethyl-iminodiacetic acid (HIDA) in difficult cases or uncertain diagnosis.
- Abdominal MRI and CT scan can also be used for the diagnosis of acute cholecystitis and it's complications. These modalities are not preferred because:
- More time is needed for the tests
- Limited availability
Diagnostic Criteria
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The diagnostic criteria for acute cholecystitis is:[6] A. Local signs of inflammation etc.
B. Systemic signs of inflammation etc. C. Imaging findings
Suspected diagnosis: One item in A + one item in B Definite diagnosis: One item in A + one item in B + C
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| Adopted from Journal of Hepato-Biliary-Pancreatic Sciences |
References
- ↑ "Gallbladder, Cholecystitis, Acute - StatPearls - NCBI Bookshelf".
- ↑ 2.0 2.1 2.2 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.
- ↑ 3.0 3.1 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.
- ↑ "Imaging of Cholecystitis : American Journal of Roentgenology : Vol. 196, No. 4 (AJR)".
- ↑ Kiewiet JJ, Leeuwenburgh MM, Bipat S, Bossuyt PM, Stoker J, Boermeester MA (2012). "A systematic review and meta-analysis of diagnostic performance of imaging in acute cholecystitis". Radiology. 264 (3): 708–20. doi:10.1148/radiol.12111561. PMID 22798223.
- ↑ Yokoe M, Takada T, Strasberg SM, Solomkin JS, Mayumi T, Gomi H, Pitt HA, Garden OJ, Kiriyama S, Hata J, Gabata T, Yoshida M, Miura F, Okamoto K, Tsuyuguchi T, Itoi T, Yamashita Y, Dervenis C, Chan AC, Lau WY, Supe AN, Belli G, Hilvano SC, Liau KH, Kim MH, Kim SW, Ker CG (2013). "TG13 diagnostic criteria and severity grading of acute cholecystitis (with videos)". J Hepatobiliary Pancreat Sci. 20 (1): 35–46. doi:10.1007/s00534-012-0568-9. PMID 23340953.