Ultrasonographic and spiral CT evaluation of simple and complicated acute cholecystitis: diagnostic protocol assessment based on personal experience and review of the literature

Macciucca, Marina De Vargas; Lanciotti, Silvia; Cicco, Maria Luisa De; Coniglio, M.; Gualdi, Gianfranco

doi:10.1007/s11547-006-0018-3

Cited by 24 publications

(12 citation statements)

References 24 publications

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“…Radiology ultrasonography has been shown to be accurate to diagnose cholelithiasis and acute cholecystitis in patients referred from the ED, 16,[21][22][23][24][25][26][27][28][29][30][31] but it is limited by its routine availability and portability. To facilitate throughput, rapidly narrow the differential diagnosis, and institute early treatment, emergency physicians are increasingly using bedside ultrasonography in the initial evaluation of patients with suspected cholecystitis.…”

Section: Discussionmentioning

confidence: 99%

A Prospective Evaluation of Emergency Department Bedside Ultrasonography for the Detection of Acute Cholecystitis

Summers

Scruggs

Menchine

et al. 2010

Annals of Emergency Medicine

128

103

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Study objective: We assess the diagnostic accuracy of emergency physician-performed bedside ultrasonography and radiology ultrasonography for the detection of cholecystitis, as determined by surgical pathology. Methods:We conducted a prospective, observational study on a convenience sample of emergency department (ED) patients presenting with suspected cholecystitis from May 2006 to February 2008. Bedside gallbladder ultrasonography was performed by emergency medicine residents and attending physicians at an academic institution. Emergency physicians assessed for gallstones, a sonographic Murphy's sign, gallbladder wall thickness, and pericholecystic fluid, and the findings were recorded before formal imaging. The test characteristics of bedside and radiology ultrasonography were determined by comparing their respective results to pathology reports and clinical follow-up at 2 weeks.Results: Of the 193 patients enrolled, 189 were evaluated by bedside ultrasonography. Forty-three emergency physicians conducted the ultrasonography, and each physician performed a median of 2 tests. After the bedside ultrasonography, 125 patients received additional radiology ultrasonography. Twenty-six patients underwent cholecystectomy, 23 had pathology-confirmed cholecystitis, and 163 were discharged home to follow-up. Twenty-five were excluded (23 lost to follow-up and 2 unavailable pathology). The test characteristics of bedside ultrasonography were sensitivity 87% (95% confidence interval [CI] 66% to 97%), specificity 82% (95% CI 74% to 88%), positive likelihood ratio 4.7 (95% CI 3.2 to 6.9), negative likelihood ratio 0.16 (95% CI 0.06 to 0.46), positive predictive value 44% (95% CI 29% to 59%), and negative predictive value 97% (95% CI 93% to 99%). The test characteristics of radiology ultrasonography were sensitivity 83% (95% CI 61% to 95%), specificity 86% (95% CI 77% to 92%), positive likelihood ratio 5.7 (95% CI 3.3 to 9.8), negative likelihood ratio 0.20 (95% CI 0.08 to 0.50), positive predictive value 59% (95% CI 41% to 76%), and negative predictive value 95% (95% CI 88% to 99%). Conclusion:The test characteristics of emergency physician-performed bedside ultrasonography for the detection of acute cholecystitis are similar to the test characteristics of radiology ultrasonography. Patients with a negative ED bedside ultrasonography result are unlikely to require cholecystectomy or admission for cholecystitis within 2 weeks of their initial presentation.

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Section: Discussionmentioning

confidence: 99%

A Prospective Evaluation of Emergency Department Bedside Ultrasonography for the Detection of Acute Cholecystitis

Summers

Scruggs

Menchine

et al. 2010

Annals of Emergency Medicine

128

103

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“…These data indicate that the detection of wall thickening by DWIBS/T2 make it an effective method in the evaluation and diagnosis of acute cholecystitis. The sensitivity of abdominal US in the diagnosis of acute cholecystitis is 37.5-91% (25,26), while the sensitivity of CT is 83% (25). In the current study, the sensitivity of DWIBS/ T2 in the diagnosis of acute cholecystitis was 90.9%.…”

Section: Discussionmentioning

confidence: 44%

Diffusion-weighted whole-body magnetic resonance imaging with background body signal suppression/T2 image fusion for the diagnosis of acute cholecystitis

Tomizawa

Shinozaki

Tanaka

et al. 2017

Experimental and Therapeutic Medicine

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Abstract. Prompt and accurate diagnosis is critical in the treatment of acute cholecystitis. Diffusion-weighted whole-body magnetic resonance imaging with background body signal suppression/T2 image fusion (DWIBS/T2) identifies areas with high signal intensity, corresponding to inflammation. In the present study, the records and images of patients with acute cholecystitis who underwent DWIBS/T2 between January 2013 and March 2014 were retrospectively analyzed. A total of 11 patients with acute cholecystitis were enrolled. In one patient, DWIBS/T2 identified a thickened wall and high signal intensity, with high signal intensity in the pericholecystic space that suggested localized peritonitis. Positive DWIBS/T2 results indicating acute cholecystitis were obtained in 10/11 patients, with a sensitivity of 90.9%. In addition, wall thickening and high signal intensity were absent in DWIBS/T2 images when wall thickening was not detected by computed tomography. Wall thickening and high signal intensity was attenuated when patients with acute cholecystitis were clinically treated. These data suggest that a thickened gallbladder wall and high signal intensity are indicative of acute cholecystitis and that DWIBS/T2 may be a useful technique in evaluating the severity of acute cholecystitis. IntroductionAcute cholecystitis is characterized by inflammation of the gallbladder and typically occurs due to obstruction of the gallbladder neck or cystic duct by a gallstone (1). Gallbladder infection may also spread to the liver or pericholecystic cavity and lead to the development of liver abscesses or peritonitis, respectively (2-4). Therefore, prompt treatment with cholecystectomy, percutaneous transhepatic gallbladder drainage or aspiration is typically recommended following diagnosis of acute cholecystitis (5-7). Accurate diagnosis is also critical for the appropriate management of acute cholecystitis (8).Diffusion-weighted whole-body magnetic resonance imaging with background body signal suppression (DWIBS) is based on a diffusion-weighted imaging (DWI) technique, which enables visualization of the random movement of water molecules (Brownian motion) for diagnostic imaging (9). Images are acquired with DWIBS during free breathing of the patient through the use of multiple-signal averaging, fat suppression and heavy diffusion weighting (10). In particular, a high signal intensity of DWIBS is a positive indicator of cancer and inflammation. An advantage of DWIBS over DWI is that it exhibits positive signals with strong contrast against surrounding normal tissues. However, the evaluation of positive signals to obtain anatomical information becomes difficult when signals in the surrounding tissues are suppressed (11,12). Images obtained from DWIBS are fused with their corresponding T2-weighted images using a workstation (13-15). DWIBS and T2-weighted image fusion (DWIBS/T2) enables anatomical evaluation of the positive signals obtained from DWIBS (16). Therefore, the present study retrospectively analyzed images obtained by DWIB...

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“…Interestingly, there is no proven relationship between aneurysm size and their propensity to rupture [6,7]. While abdominal ultrasound is helpful in detecting acute calculous cholecystitis, it is not generally helpful in identifying PDAA; however, CT with contrast is a relatively quick and noninvasive procedure that has proven to be extremely useful in confirming the presence of splanchnic artery aneurysms [12]. For a definitive diagnosis of PDAA, angiographic examination is essential, but the patient must be hemodynamically stable.…”

Section: Introductionmentioning

confidence: 99%

“…Since patients with ruptured PDAA are often either in shock or have a history of syncope, it is frequently tempting to bypass angiography in favor of prompt surgical exploration. However, intraoperative arteriography employing injections into the superior mesenteric artery and celiac axis should be undertaken to define the origin of hemorrhage [12]. With the recent advances in interventional techniques of visceral aneurysms, transcatheter embolization is increasingly performed to treat PDAA [5,8,10,[14][15][16][17][18].…”

Section: Introductionmentioning

confidence: 99%

Ruptured Pancreaticoduodenal Artery Aneurysm Combination with Acute Calculus Cholecystitis

Yi¹,

Kung²,

Hsu³

et al. 2007

Visc Med

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Pancreaticoduodenal artery aneurysms are rare, and their timely diagnosis and successful management, when combined with acute cholecystitis, is extremely challenging. Case Report A 56-year-old male was admitted to the Kaohsiung Armed Forces General Hospital with complaints of gastralgia in the right upper quadrant of the abdomen. Ultrasound examination of the abdomen demonstrated acute cholecystitis and cholelithiasis. A laparoscopic cholecystectomy was aborted upon observation of a retroperitoneal hematoma. CT and superior mesenteric artery angiography identified a ruptured aneurysm arising from the posterior pancreaticoduodenal artery. Emergency laparotomy confirmed the presence of acute cholecystitis, cholelithiasis, and a ruptured pancreaticoduodenal artery aneurysm involving the posterior aspect of the pancreatic head. The postoperative course following aneurysmectomy and cholecystectomy was complicated by pancreatitis, but on the 46th postoperative day the patient could be discharged in good condition. Conclusions: This is a noteworthy case since pancreaticoduodenal artery aneurysms are uncommon and ruptured pancreaticoduodenal artery aneurysms are associated with a high mortality rate.

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Ultrasonographic and spiral CT evaluation of simple and complicated acute cholecystitis: diagnostic protocol assessment based on personal experience and review of the literature

Abstract: If more than two major signs associated with one minor sign or at least one sign of complication are present at US, CT is mandatory to recognise and thoroughly evaluate the type of complication and indicate appropriate treatment.

Cited by 24 publications

References 24 publications

A Prospective Evaluation of Emergency Department Bedside Ultrasonography for the Detection of Acute Cholecystitis

A Prospective Evaluation of Emergency Department Bedside Ultrasonography for the Detection of Acute Cholecystitis

Diffusion-weighted whole-body magnetic resonance imaging with background body signal suppression/T2 image fusion for the diagnosis of acute cholecystitis

Ruptured Pancreaticoduodenal Artery Aneurysm Combination with Acute Calculus Cholecystitis

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