Cholecystitis


Images by Genevieve Carbonatto

Ultrasound is the best imaging modality to diagnose cholecystitis. Cholecystitis is a frequent presentation to the Emergency department. The hall marks include

  • Thickening of the gallbladder wall > 3mm
  • Gallstones
  • Impacted stones in the cystic duct or gall bladder neck
  • Pericholecystic fluid
  • +ve Murphy’s sign
  • Hyperaemic gallbladder wall on colour or power Doppler.

The following are examples of patients presenting with abdominal pain where a diagnosis of cholecystitis was made:

Case 1.

Ultrasound shows

  • Pericholecystic fluid
  • thickened GB wall
  • Multiple stones
  • Sludge

Case 2

Ultrasound shows

  • Impacted stone in neck of GB. The stone was only visible when the patient was examined standing
  • Thickened GB wall o.45 cm.  Stone 2.14 cm

 

Case 3

Ultrasound shows

  • Thickening of gall bladder wall 0.48 cm
  • Pericholecystic fluid
  • Stone in neck of gall bladder
  • Gall bladder perforation (free fluid surrounding GB). Confirmed in theatre. Abdomen full of bile.

 

 

 

 

 

 

 

 

Free fluid

Case 4

Ultrasound shows

  • GB full of debris
  • GB wall thickening
  • Pericholecystic fluid

This patient was very ill with fever and abdominal pain. Gallbladders which are full of debris like this may be difficult to identify.

Case 5

Ultrasound shows

  • Stone in neck of gallbladder
  • Sludge
  • Pericholecystic fluid
  • GB wall thickening 0.83 cm

Case 6

Ultrasound shows

  • Thickened GB wall
  • Pericholecystic fluid
  • Gall stone in neck of GB ( 2.11 cm)
  • Sludge

Case 7

Ultrasound findings

  • Thickened gallbladder wall
  • Stone in neck of gall bladder
  • Pericholecystic fluid
  • Sludge fills gall bladder proximal to the impacted stone
  • Hyperaemia of wall with power Doppler

 

 

 

 

 

 

 

Leave a Reply

Your email address will not be published.