Finding-the-Path: Abdominal ultrasound
Abdominal ultrasonography
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.
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, a 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 nonbiliary pathology, it is often reserved for patients whose sonograms are equivocal for diagnosis of acute cholecystitis.
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Abdominal ultrasonography
