Skip Navigation

Findings in Acute Cholecystitis

9/21/12 -  This week’s ultrasound image is brought to us by Drs. Menelaos Demestihas and Justin Schrager who performed a right upper quadrant exam on a 61 year old woman with a long history of alcohol abuse who presented with worsening abdominal pain and jaundice.

Image 1

unlabeledsludge 

Image 1 shows:

  1. significant gallbladder sludge with no stones,
  2. fluid around the gallbladder,
  3. a thickened gallbladder wall.
Image 2

labeledsludge

When evaluating a patient for acute cholecystitis we look for 4 key features:

  1. The presence or absence of stones or sludge in the gallbladder. Stones are hyperechoic with shadowing. Sludge, as seen in this case, does not typically shadow. 
  2. Gall Bladder wall thickening. A perpendicular measurement is taken of the anterior wall. (A normal measurement is 3mm or  less)
  3. The presence or absence of peri-cholecystic fluid (PCCF). This is usually found in wedges around an acutely inflamed gallbladder wall. 
  4. The presence of absence of a sonographic Murphy’s sign. An ultrasonic Murphy’s sign is positive when the point of maximal tenderness is in the right upper quadrant while the gallbladder is in view on the ultrasound monitor. Multiple points in the epigastrium and right upper quadrant must be tested in order to properly evaluate this sign. The sensitivity of a sonographic Murphy’s sign is reported from 75-86% with a positive predictive value of 92% when combined with the finding of gallstones.

In addition if we are concerned for choledocholithiasis or cholangitis we can evaluate the common bile duct (CBD). (A normal measurement is less than 4 mm in a patient under 40 years of age, you may allow an additional 1 mm for every decade over 40).

In this case the patient had underlying liver disease with ascities. This can cloud the picture as ascites is difficult to distinguish from pericholecystic fluid. Ascites can also cause gallbladder wall thickening.  This patient was admitted for further diagnostic testing. 

Great job this week! Remember to keep hitting “record” and logging those scans.

-pt