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
• presentation
  • constant right upper quadrant pain
    • colicky pain is more likely to be secondary to biliary colic
  • pain may radiate to shoulder tip
• 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