Chronic acalculous gallbladder disease: multiimaging evaluation with clinical-pathologic correlation

Cross-Sectional Imaging of Acute and Chronic Gallbladder Inflammatory Disease

“…This condition almost always arises in the setting of cholelithiasis. Patients may have a history of recurrent acute cholecystitis or biliary colic, although some patients may be asymptomatic [32]. Microscopically, there is evidence of chronic inflammation within the gallbladder wall.…”

Lymphocytic Cholecystitis/Cholangitis

“…About 13% of patients with biliary symptoms attributable to chronic cholecystitis do not have gallstones. 2 It has become apparent that in many of these patients, the inflammatory lesions in the gallbladder may be a reflection of a generalized cholangitis.…”

Chronic Acalculous Cholecystitis

“…5,7,[10][11][12] The female-to-male ratio is lower and the mean age is higher in acute acalculous cholecystitis than the more common chronic calculous form. 4 The diagnosis of chronic acalculous cholecystitis, although suspected clinically, can seldom be confirmed precisely by routine radiologic and laboratory studies. Nevertheless, in the majority of cases, the correct diagnosis can be made on the basis of age, sex, and accurate history-taking in the presence of convincing symptoms.…”

“…7,9,14 Radionucleotide imaging with or without CCK stimulation has also been the subject of conflicting reports in the diagnosis of acalculous disease. 4,9 It would seem, therefore, that despite the increasing sophistication of biliary tract investigation, the diagnosis of chronic acalculous cholecystitis remains predominantly clinical in the presence of typical symptoms and relies on the exclusion of other upper abdomen pathology. Nevertheless, a satisfactory outcome following cholecystectomy has been reported in 80% to 90% of patients with symptoms similar to those in cholelithiasis, 5,9,10 irrespective of the diagnostic methods used to select patients for surgery, and findings in the present series agree with such results.…”