Discussion of Acute cholecystitis
- Acute cholecystitis is the most common cause of acute pain in the right upper quadrant (RUQ).
- Urgent surgical removal of the gallbladder is the treatment of choice for uncomplicated disease.
- Ninety percent to 95% of cases are due to calculous obstruction of the gallbladder neck or cystic duct leading to increased intraluminal pressure and distention.
- Inflammation may result from chemical injury of the mucosa by bile salts and/or superimposed infection.
- Gallbladder ischemia and transmural necrosis may occur if the obstruction persists.
- Differential diagnosis for acute cholecystitis is extensive and includes:
- Gangrenous cholecystitis
- Emphysematous cholecystitis
- Gallbladder perforation
- Cholecystoenteric fistula
 Imaging Findings for Acute cholecystitis
- Tensely distended gallbladder
- Most sensitive US finding in acute cholecystitis is the presence of cholecystolithiasis in combination with the sonographic Murphy sign.
- Both gallbladder wall thickening (>3 mm) and pericholecystic fluid are secondary findings that are neither sensitive nor specific for acute cholecystitis.
- Every effort should be made to demonstrate the obstructing stone in the gallbladder neck or cystic duct.
- Nonvisualization of the gallbladder
Patient #1: CT demonstrates findings that are consistent with acute cholecystitis (gallstone in GB neck, perichol fluid, GB wall thickening)
Patient #2: MR images demonstrates findings that are consistent with acute cholecystitis (perichol fluid, GB wall thickening)
 See also
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 References for Acute cholecystitis
- Anthony E. Hanbidge, Philip M. Buckler, Martin E. O’Malley, and Stephanie R. Wilson. From the RSNA Refresher Courses: Imaging Evaluation for Acute Pain in the Right Upper Quadrant. RadioGraphics 2004 24: 1117-1135.