Follow-up sonography in suspected acalculous cholecystitis: preliminary clinical experience

Abstract

Fourteen adult patients with clinically suspected AAC and inconclusive initial sonograms underwent follow‐up sonography within 24 hours. Eight patients had initial studies demonstrating a normal thickness of the gallbladder wall. Four of these patients demonstrated progressive thickening of the gallbladder wall on follow‐up scans and were diagnosed as having AAC. In three of these patients AAC was proved at surgery, and the remaining patient improved clinically after percutaneous cholecystostomy. Four other patients with normal gallbladder wall thickness on both the initial and follow‐up sonograms had benign clinical follow‐up results without evidence of AAC. The remaining six patients had a thickened gallbladder on the initial sonogram. In one of these patients, the gallbladder wall thickening resolved on follow‐up sonography. In the remaining five patients the gallbladder wall thickening did not change. Four of these patients had benign follow‐up results but one patient was found to have AAC at surgery. Follow‐up sonography may be helpful to confirm AAC if there is progressive edema of the gallbladder wall. A normal gallbladder wall on an initial study does not exclude early AAC. Thickening of the gallbladder wall on initial studies still remains a problem and other ancillary criteria must be used to establish the diagnosis of AAC.

Prevalence and Significance of Gallbladder Abnormalities Seen on Sonography in Intensive Care Unit Patients

“…A combination of these abnormal clinical and biochemical parameters were likely the cause of the frequent abnormal sonographic findings [4,10]. This is in keeping with the earlier reports in the literature that suggested that the sensitivity and specificity of sonographic findings in acalculous cholecystitis in critically ill patients is low [1,2].…”

“…Gallbladder sludge or echogenic bile may be a result of bile stasis from fasting, parenteral nutrition, or functional obstruction of the Oddi's sphincter after narcotic analgesic administration [4]. Furthermore, normal sonographic appearances do not necessarily rule out early acalculous cholecystitis [10]. Another report has also suggested that color Doppler sonography of the gallbladder may be helpful in distinguishing acute cholecystitis from a normal gallbladder [11].…”

Sonomorphology of the gallbladder in critically ill patients

“…A follow-up examination that shows increasing GB wall thickening appears to be a good indication of AC (11). However, in this study patients with GB wall thickening on the initial sonogram remained a problem (11). Conversely, we had no patients with an initial normal sonogram of the GB in our study.…”

“…To-date, US is often the initial imaging modality in critically ill patients who are suspected of having AC (1,(5)(6)(7)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22)(23)(24)28). Despite the great variation in sensitivity and specificity for US diagnosis of AC (1, 5-7, 10-13, 16, 17, 19, 21-23, 26, 28), other imaging modalities are either not available in the ICU or do not perform superiorly to US (2,6,16,23,25).…”

Hydropic gallbladder in a child due to hepatitis A infection

“…Diagnosis is established by ultrasonography of the abdomen demonstrating normal biliary ducts and a distended gallbladder without calculi or congenital malformation. The ultrasonographic criteria for diagnosing acute acalculous cholecystitis (AAC) include (1) gallbladder distention; (2) thickening of the gallbladder wall (>3.5 mm); (3) no acoustic shadow or biliary sludge; (4) perivesical liquid accumulation; and (5) no dilatation of the intra-and extrahepatic bile ducts [5].…”