Acute calculous cholecystitis

  • Ultrasound is best initial investigation – definitive in 80% cases
  • 90-95% of cases of cholecystitis due to stones
Imaging
  • USG
    • Gall bladder wall thickness > 3 mm has 95% positive predictive value
    • Gall bladder distension (diameter >5 cm)
    • Pericholecystic fluid
    • Gall bladder wall striations
    • Wall hyperemia occasionally on Doppler
    • If labs show signs of cholestasis, rule out CBD stone
  • CT
    • Less accurate
    • Gall bladder wall thickening 
    • Subserosal edema
    • Gall bladder distension
    • High-density bile
    • Pericholecystic fluid 
    • Inflammatory stranding in pericholecystic fat
Read more

Altun, Ersan, et al. “Acute cholecystitis: MR findings and differentiation from chronic cholecystitis.” Radiology 244.1 (2007): 174-183.

Hanbidge, Anthony E., et al. “From the RSNA refresher courses: imaging evaluation for acute pain in the right upper quadrant.” Radiographics 24.4 (2004): 1117-1135.