Acute Acalculous Cholecystitis

• Published in: Applied radiology (1976) Vol. 52; no. 6; pp. 36 - 38
• Main Authors: Chroneos, Paul C., Towbin, Richard B., Schaefer, Carrie M., Towbin, Alexander J.
• Format: Journal Article
• Language: English
• Published: Scotch Plains Anderson Publishing Ltd 01-11-2023
• Subjects: Abdomen; Anorexia; Calculi; Cholecystectomy; Computed tomography; Edema; Gallbladder; Gallbladder diseases; Gallstones; Gastroenterology; Morphine; Pediatrics; Sepsis; Sludge; Surgery; Thickness; Ultrasonic imaging; Viral infections
• ISSN: 1879-2898; 0160-9963; 1879-2898
• DOI: 10.37549/AR2930

Imaging Findings An ultrasound of the gallbladder (GB) demonstrated a sludge-filled and distended GB with marked wall thickness, but no significant pericholecystic fluid (Figure 1). Prior studies have shown that ultrasound has equal sensitivity and superior specificity compared to CT, MRI, and hepatobiliary iminodiacetic acid (HIDA) scanning.5 In the absence of gallstones, at least two of the following findings are required to diagnose cholecystitis: GB wall edema, increased wall thickness (>3.5-4 mm), pericholecystic fluid, intraluminal sludge, or GB distention.6 A sonographic Murphy sign, defined as maximal abdominal tenderness from pressure of the ultrasound probe over the GB, may also be present. On computed tomography, AAC appears with increased GB wall thickness >3-4 mm, pericholecystic fluid, subserosal edema, intramural gas, GB sludge, and hydrops.7 Unfortunately, CT is not always sensitive to gallstones. [...]excluding AAC from the differential diagnosis is difficult.