Learning objectives
This exhibit will:
Describe the complications acute cholecystitis can have and its pathophysiology through a pictorial review.
Review the different complications that acute cholecystitis can have and its main imaging findings on US, CT and MRI.
Background
Gallbladder and bile duct pathologies are the most frequent causes of right upper quadrant pain (1,2). Among these, acute cholecystitis is one of the first diagnostic considerations.
[Fig 1][Fig 2]
Acute cholecystitis consists of inflammation of the gallbladder, being in up to 95% of cases secondary to gallstones (3). Acute calculous cholecystitis is more common in women, although the clinical picture may be more severe in men and patients with other comorbidities.
Its pathophysiology is intuitive:
Emptying of the gallbladder is compromised by an obstructive...
Findings and procedure details
A. Gangrenous cholecystitis
When acute cholecystitis is severe or prolonged in time, excessive gallbladder distension leads to increased intraluminal pressure that can reach a point where the vascularization of the wall is compromised, with subsequent necrosis.
Gangrenous cholecystitis is the most common complication of acute cholecystitis, accounting for up to 30% of cases. An increased risk of gangrenous cholecystitis has been reported in elderly male patients with diabetes mellitus, elevated bilirubin and coronary artery disease. Due to parietal necrosis, US Murphy's sign may be negative...
Conclusion
-Abdominal US is the optimal initial approach for urgent pathology of the gallbladder and biliary tree. However, CT is often preferred when major complications are suspected.
-Acute cholecystitis represents the last step in the spectrum of simple biliary colic, and we should use all diagnostic and analytical clues to diagnose it.
-Acute cholecystitis is a continuum and its progression to complicated cholecystitis depends on the patient's comorbidities and the severity of the disease.
-Emphysematous cholecystitis is a life-threatening condition that should not be confused with...
Personal information and conflict of interest
D. Herrán De La Gala:
Nothing to disclose
D. Castanedo Vázquez:
Nothing to disclose
T. Cobo Ruiz:
Nothing to disclose
C. Cantolla Nates:
Nothing to disclose
M. Barrios López:
Nothing to disclose
R. Pellón Daben:
Nothing to disclose
J. Crespo del Pozo:
Nothing to disclose
S. Sánchez Bernal:
Nothing to disclose
References
Hanbidge AE, Buckler PM, O’Malley ME, Wilson SR. Imaging evaluation for acute pain in the right upper quadrant. Radiographics. 2004;24(4):1117–35.
Joshi G, Crawford KA, Hanna TN, Herr KD, Dahiya N, Menias CO. US of Right Upper Quadrant Pain in the Emergency Department: Diagnosing beyond Gallbladder and Biliary Disease. RadioGraphics. 2018 May;38(3):766–93.
Reiss R, Deutsch AA. State of the Art in the Diagnosis and Management of Acute Cholecystitis. Dig Dis. 1993;11(1):55–64.
Friedman GD. Natural history of asymptomatic and symptomatic gallstones. Am J Surg. 1993 Apr;165(4):399–404.
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