Ultrasound of Acute Cholecystitis

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In this radiology lecture, we review the ultrasound appearance of acute cholecystitis, including gangrenous and emphysematous cholecystitis! • Key teaching points include: • 1) Acute cholecystitis = Acute gallbladder inflammation. • 2) Most often (95%) caused by an impacted, obstructing gallstone in the cystic duct or gallbladder neck = Acute calculous cholecystitis. • 3) Clinically presents as persistent RUQ pain that may radiate to right shoulder, often with N/V and fever. • 4) Ultrasound findings of uncomplicated acute cholecystitis: Gallstones, sonographic Murphy sign, gallbladder wall thickening (greater than 3 mm) and edema, gallbladder distention (greater than 4 cm short axis), and pericholecystic fluid. • 5) Sonographic Murphy sign = Maximal abdominal tenderness from transducer pressure over gallbladder. PPV of gallstones and a positive sonographic Murphy sign = 92%. • 6) Pericholecystic fluid occurs in less than 20% of patients with acute cholecystitis, usually seen in more advanced cases. • 7) Gangrenous cholecystitis = Most common complication of acute cholecystitis. Ischemia with necrosis of gallbladder wall. Increased mortality compared to uncomplicated acute cholecystitis. • 8) Ultrasound findings of gangrenous cholecystitis: Wall disruption, ulceration, mucosal irregularity, and/or focal bulge, sloughed mucosal membranes, pericholecystic fluid, less likely to have positive Murphy sign, and increased risk of perforation (usually at fundus). • 9) Emphysematous cholecystitis = Gallbladder wall necrosis with gas formation in wall and/or lumen. More common in elderly men with underlying diabetes. Higher risk of perforation, rapid progression, and increased mortality compared to uncomplicated acute cholecystitis. Emergent surgical intervention typically required. • 10) Ultrasound findings of emphysematous cholecystitis: Bright reflectors from nondependent portions of gallbladder wall, dirty posterior acoustic shadowing, and ring-down artifact. CT can confirm if necessary. • To learn more about the Samsung RS85 Prestige ultrasound system, please visit: https://www.bostonimaging.com/rs85-pr... • Click the YouTube Community tab or follow on social media for bonus teaching material posted throughout the week! • Website: https://radiologisthq.com/ • Spotify Video Podcast: https://bit.ly/spotify-rhq • Apple Video Podcast: http://bit.ly/radiologistHQ • Instagram: / radiologisthq • Facebook: / radiologistheadquarters • Twitter: / radiologisthq • Reddit: / radiologisthq

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