Learning objectives
To illustrate and describe the findings of acute and chronic cholecystitis,
highlighting the complementary role of Ultrasound (US) and Computed Tomography (CT).
To illustrate complications of acute cholecystitis namely gangrenous cholecystitis,
haemorrhagic cholecystitis,
perforated cholecystitis,
emphysematous cholecystitis,
gallbladder empyema and acute cholecystitis with hepatic abscess.
To illustrate other associated conditions namely choledocholithiasis,
choledochoduodenal fistula,
gallstone ileus,
Mirizzi syndrome and dropped gallstones
Background
Cholecystitis is inflammation of the gallbladder,
most often secondary to cholelithiasis[1].
Acute acalculous cholecystitis is inflammation of the gallbladder in the absence of cholelithiasis which occurs in approximately 10% of all cases of acute cholecystitis,
usually in patients who are diabetic,
critically ill or with prolonged illness[2].
The multiple forms of cholecystitis are the most common surgical entity encountered in developed countries[3].
Approximately 380 000 medical presentations per year in Australia are attributed to gallbladder disease[4].
Disorders of the gallbladder,
biliary tree and liver may...
Imaging findings OR Procedure details
Fig.
1
ACUTE CHOLECYSTITIS
Acute cholecystitis is acute inflammation of the gallbladder and is often caused by gallstones,
leading to outflow obstruction[1,
2].
It has a mortality rate of 4%[5].
Plain abdominal radiographs are of limited value as only 20% of gallstones are radio-opaque[3] and gallbladder inflammation cannot be visualised.
US is the imaging modality of choice and findings include the following with the first two being the most specific ( Fig. 1 )[2]:
Gallstones which appear as mobile and highly reflective echoes with posterior...
Conclusion
Being such a common entity,
it is imperative that Sonographers,
Radiology Registrars and Consultants are familiar with the different imaging findings.
This project aims to portray the common presentations of cholecystitis and its complications.
Additionally,
Radiologists can also perform image-guided percutaneous cholecystostomies in patients unfit for cholecystectomies under general anaesthesia.
Personal information
Joel is a 2nd year Radiology Registrar in the Western Australia Radiology Training program.
Chandra (Padmini) is a Consultant Abdominal and General Radiologist at Royal Perth Hospital.
References
1.
Kimura Y,
Takada T,
Kawarada Y,
Nimura Y,
Hirata K,
Sekimoto M,
et al.
Definitions,
pathophysiology,
and epidemiology of acute cholangitis and cholecystitis: Tokyo Guidelines.
J Hepato-biliary-pan.
2007;14:15-26.
2.
Bennett GL.
Evaluating Patients with Right Upper Quadrant Pain.
Radiol Clin N Am.
2015;53:1093-1130.
3.
Elwood DR.
Cholecystitis.
Surg Clin N Am.
2008;88:1241-52.
4.
Bayram C,
Valenti L,
Miller G.
Gallbladder disease.
AFP.
2013;42(6):443.
5.
Nikfarjam M,
Harnaen E,
Tufail F,
Muralidharan V,
Fink M,
Starkey G,
et al.
Sex differences and outcomes of management...