Ultrasound in diagnosing acute calculous cholecystitis
Suzzanna Leeming, Radiology, Sheffield Teaching Hospital and University of Leeds
Background
Acute cholecystitis affects about 1 in 10 adults in the United Kingdom (National Health Service (NHS) choices, 2016). This case study identifies a patient with suspected gallstone disease and the role of ultrasound in the diagnosis and outcome.
Case Report
A 44 year old female presented to the Accident and Emergency (A&E) department with an acutely tender upper abdomen. A previous ultrasound examination reported a solitary, mobile gallstone.
The ultrasound examination revealed a solitary, immobile gallstone in the neck of the gallbladder, smaller mobile gallstones in the fundus and biliary debris. The gallbladder wall appeared thickened and oedematous with hyperaemic vascularity. The patient also displayed a positive Murphy’s sign. Using the clinical signs and ultrasound a diagnosis of acute calculous cholecystitis was made. The patient had a laparoscopic cholecystectomy and made a full recovery.
Discussion
Early diagnosis is imperative to relieve pain and plan for surgical management for patients with acute calculous cholecystitis. The accuracy of ultrasound in diagnosing acute calculous cholecystitis has been described as imperfect; its sensitivity is widely varied between studies. However ultrasound has a high sensitivity and specificity in detecting cholelithiasis which is one of the main findings in acute cholecystitis and in this case. Other imaging characteristics in this case such as wall thickening, pericholecystic fluid and specifically a positive Murphy’s sign, improve ultrasound’s ability alone to diagnose acute calculous cholecystitis.
This patient underwent a laparoscopic cholecystectomy within 5 days as recommended by NICE (2015). There is much discussion into the advantages and disadvantages of both laparoscopic surgery and open surgery and much depends on the severity of the inflammation. This case was successfully treated using laparoscopic methods which is less invasive.
In this case ultrasound alone was able to efficiently conclude and diagnose acute calculous cholecystitis.