CT findings of mild forms or early manifestations of acute cholecystitis☆
Introduction
Acute cholecystitis accounts for 3–10% of all patients with abdominal pain and is the most common cause of acute abdominal pain in the right upper quadrant, especially in the elderly patients [1]. Traditionally, sonography has been used as the initial imaging technique for evaluating patients with suspected gallbladder (GB) disease because of its high sensitivity at the detection of GB stones, its real-time character, and its speed and portability [2]. However, because CT has become popular for evaluating the acute abdomen, it is often the first technique used to evaluate patients with suspected GB disease [3], [4], [5], [6].
The recent introduction of the multidetector CT (MDCT) scanner for abdominal imaging has allowed acquisition of optimum dynamic imaging with high temporal resolution and a high z-axis resolution [6], [7]. Therefore, MDCT is frequently used to determine the causative factor of abdominal pain to drive an accurate clinical decision [6], [7]. Accordingly, mild forms or early manifestations of acute abdominal disease appear to be more frequently demonstrated on CT than their well-known typical imaging findings or their severe forms. In daily clinical routines, we have frequently encountered patients that were considered to have acute cholecystitis but had no well-known typical imaging findings of acute cholecystitis upon initial CT examination. If CT is performed as the initial imaging modality for evaluating the acute abdomen, recognition of CT findings of the mild forms or early manifestations of acute cholecystitis may eliminate the need for any additional imaging modalities and prevent delayed diagnosis or misdiagnosis, thereby facilitating appropriate and expedient management. Therefore, this study was conducted to determine the MDCT findings of the mild forms or early manifestations of acute cholecystitis and to identify their most reliable CT feature.
Section snippets
Patient population
Between October 2004 and March 2008, we searched the computerized medical records of our hospital to identify patients who had been diagnosed with acute cholecystitis and performed three-phasic dynamic MDCT scans at our hospital, which is a tertiary referral hospital. The protocols of this study were approved by the institutional review board at our hospital. Patient consent was not required for this study. A total of 310 patients were given a final diagnosis of acute cholecystitis on the basis
Results
The mean values of each CT score for the patient group and the control group are shown in Table 1. There were significant differences in the mean values observed for each categoric CT feature but increased attenuation of the GB bile between the patient group and the control group [pericholecystic increased attenuation at arterial phase imaging (P<.0001), indistinctness of the interface between the GB and the liver (P<.0001), enhancement of the GB wall (P<.02), and increased attenuation of the
Discussion
In this study, we analyzed the CT findings of patients who were diagnosed with acute cholecystitis but had no definitive initial CT features that fulfilled the criteria for acute cholecystitis. We considered our study cases as a mild form or early manifestation of acute cholecystitis. There were several explanations for this. First, the clinical features of all of the study populations were compatible with those of acute cholecystitis. All of the patients had been admitted to the emergency care
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Cited by (23)
ACR Appropriateness Criteria® Right Upper Quadrant Pain: 2022 Update
2023, Journal of the American College of RadiologyPrecordial pain caused by a hemocholecyst due to gallbladder cancer: A case report
2023, International Journal of Surgery Case ReportsCitation Excerpt :This shows that precordial pain can occur without coronary artery disease. Although blood examination did not reveal an inflammatory reaction at the time the patient was admitted, increased pericholecystic attenuation on arterial-phase CT, which is an early manifestation of acute cholecystitis, suggested developing hemorrhagic cholecystitis [19]. As noted previously, we could not diagnose GBC preoperatively.
ACR Appropriateness Criteria <sup>®</sup> Right Upper Quadrant Pain
2019, Journal of the American College of RadiologyCitation Excerpt :Although it has not been advocated as a primary imaging examination for acute right upper quadrant pain, CT with IV contrast can confirm or refute the diagnosis of acute cholecystitis in equivocal cases based on US or scintigraphy, with a negative predictive value approaching 90% [12]. CT may reveal such complications as gangrene, gas formation, intraluminal hemorrhage, and perforation [7-9,12,15-19]. Furthermore, CT has been advocated as a useful modality in preoperative planning, with the absence of gallbladder wall enhancement or presence of a stone within the infundibulum associated with conversion from laparoscopic to open cholecystectomy.
Prediction of difficult laparoscopic cholecystectomy for acute cholecystitis
2017, Journal of Surgical ResearchUse of dynamic CT attenuation value for diagnosis of acute gangrenous cholecystitis
2016, American Journal of Emergency MedicineCitation Excerpt :Therefore, in cases of acute cholecystitis, arterial blood flow to the gallbladder wall increases and early venous drainage from the gallbladder wall to the liver parenchyma adjacent to the gallbladder subsequently increases [7,8]. Hence, transient focal enhancement of the liver adjacent to the gallbladder in acute cholecystitis is a characteristic finding of dynamic CT [3,4]. However, this finding cannot differentiate between gangrenous cholecystitis and nongangrenous cholecystitis.
Evaluating Patients with Right Upper Quadrant Pain
2015, Radiologic Clinics of North AmericaCitation Excerpt :A finding that suggests gallbladder inflammation that may be observed at CT is increased contrast enhancement in the liver parenchyma adjacent to the gallbladder106–108 (see Fig. 25B). This finding can help to establish the diagnosis when other findings are equivocal, and may be observed earlier than other CT findings.109 Increased density of the gallbladder wall has been described as a finding on unenhanced CT in approximately 51% of patients with acute cholecystitis.110
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This study was supported by a grant from the National R&D Program for Cancer Control, Ministry of Health and Welfare, Republic of Korea (0620220).