Acute cholecystitis (summary)
This is a basic article for medical students and other non-radiologists
Acute cholecystitis refers to the acute inflammation of the gallbladder. It is the primary complication of cholelithiasis and the most common cause of acute pain in the right upper quadrant (RUQ).
Reference article
This is a summary article; read more in our article on acute cholecystitis.
Summary
- epidemiology
- most common in those with gallstones
- fat, fertile (20-40 years), female patients
- most common in those with gallstones
- presentation
- constant right upper quadrant pain
- colicky pain is more likely to be secondary to biliary colic
- pain may radiate to shoulder tip
- constant right upper quadrant pain
- pathophysiology
- 95% of cases are due to impacted gallstones
- investigation
- US best test to confirm acute cholecystitis
- CT to assess for complications
- treatment
- fast, IV fluids and pain relief
- cold cholecystectomy (laparoscopic or open)
- prognosis
- prognosis depends on severity and complications
- complications
- necrosis and gallbladder gangrene
- abscess formation
- perforation
- fistulae
Role of imaging
- confirm the presence of gallstones
- determine if there is any evidence of acute gallbladder inflammation
- look for evidence of complications
Radiographic features
Ultrasound
- most sensitive finding
- lack of movement of impacted echogenic gallstones and sonographic Murphy sign
- secondary findings
- gallbladder wall thickening (>3 mm)
- pericholecystic fluid
- less specific findings
- gallbladder distension (diameters: longitudinal >9cm and transverse >4cm)
- sludge
CT
CT is much less sensitive than ultrasound in the assessment of cholecystitis. Gallstones may be very difficult to see at CT. Findings include:
- gallbladder distension
- gallbladder wall thickening
- pericholecystic fluid and inflammatory fat stranding
- tensile gallbladder fundus sign
- fundus bulging the anterior abdominal wall
