Education Icon

Acute Cholecystitis

Leyla Azmoun, MD
Piran Aliabadi, MD
B Leonard Holman, MD

November 14, 1995

Presentation

A 20-year-old woman presented to the emergency room with right upper quadrant (RUQ) pain, nausea and vomiting after eating fried chicken for dinner. On physical examination, she had a temperature of 38 degrees Celsius and moderate RUQ tenderness. Her white blood cell count (WBC) was 15 K/ml.

Imaging Findings

Abdominal ultrasonography

Plain radiographs of the abdomen were unremarkable.

Abdominal ultrasound demonstrates a gallstone lodged within the cystic duct (arrow). There is thickening of the gallbladder wall (arrow), measuring 5.3 mm. A small amount of pericholecystic fluid is present (arrow). The common bile duct is not dilated (arrow). These findings are consistent with acute cholecystitis.

Diagnosis

Acute cholecystitis

Discussion

Acute cholecystitis occurs in approximately one third of patients with gallstones and is caused by obstruction of the cystic duct by an impacted calculus. This results in gallbladder wall inflammation which may lead to infection and necrosis. Sonography is a sensitive (85-95%) and specific (64-100%) modality for diagnosis of acute cholecystitis. The diagnostic criteria include cholelithiasis, sonographic Murphy's sign with maximal tenderness over the sonographically localized gallbladder, gallbladder wall thickening greater than 3mm, pericholecystic fluid, and gallbladder dilatation.

Hepatobiliary imaging with technetium-99m (Tc-99m-IDA) compounds is also sensitive and accurate for diagnosis of acute cholecystitis. However, the majority of patients with RUQ pain do not have acute cholecystitis. Since nuclear hepatobiliary scintigraphy is not as sensitive as ultrasound for making a nonbiliary diagnosis, it is often reserved for patients whose sonograms are equivocal for diagnosis of acute cholecystitis.

Dear Visitors: Nothing on this World Wide Web site should be considered medical advice. Only your own doctor can help you make decisions about your medical care. It is not the policy of the Brigham and Women's Hospital Department of Radiology to provide consultation on the World Wide Web or via e-mail. If you have a specific medical question or are seeking medical care, please call the Brigham and Women's Hospital toll-free physician referral line at 1-800-294-9999.

Is this a mirrored page?
The official homepage of the BrighamRAD Teaching Case Database is http://brighamrad.harvard.edu/education/online/tcd/tcd.html

Contact the BrighamRAD Design Team for additional information about this website.