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Acute cholecystitis (CT and ultrasound)

Case contributed by Andrei Dumitrescu
Diagnosis almost certain

Presentation

Upper right abdominal pain, increasing during the last 3 days. Elevated CRP.

Patient Data

Age: 30 years
Gender: Female
ultrasound

Layered appearance of the gallbladder wall with thickening up to 5 mm. Solitary gallbladder stone at the infundibulum, about 1.5 cm in size, with dorsal shadowing.

Hyperdensity of the gallbladder wall due to increased contrast uptake. Thin layer of pericholecystic liquid. Gallstone at the infundibulum measuring 16 mm. 

Case Discussion

Ultrasound and CT both demonstrate acute cholecystitis, albeit somewhat differently. At the ultrasound, diagnosis of acute cholecystitis relies on demonstrating thickening and typical inflammatory layering of the gallbladder wall, while CT usually shows increased contrast uptake and pericholecystic fluid. Discrepancies sometimes occur, with occasional false negatives at both modalities. Also, CT may miss radiolucent gallstones (e.g. cholesterol gallstones), which would be readily apparent at the ultrasound. Ultrasound is the preferred modality in the setting of strongly suspected cholecystitis and/or cholecystolithiasis. CT may be more appropriate in a less defined clinical setting when a broad range of possible pathology has to be ruled out.

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