Acute cholecystitis echocardiography and ultrasound

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Furqan M M. M.B.B.S[2]

Transabdominal ultrasound is the initial test of choice for the diagnosis of acute cholecystitis. Findings on an ultrasound diagnostic of acute cholecystitis include thickened gallbladder, gallstones or sludge, and pericholecystic fluid.

• Transabdominal ultrasonography is the initial test of choice for the diagnosis of acute cholecystitis and gallstones.^{[1][2][3][4][5]}
  • Findings on an transabdominal ultrasonography diagnostic of acute cholecystitis include:
    • Thickened gallbladder (>4 mm)
    • Gallstones or sludge
    • Pericholecystic fluid
  • Acalculous cholecystitis may only show a distended gallbladder

• Acute calculous cholecystitis is diagnosed radiologically by the presence of
  • Thickening of gallbladder (5mm or greater)
  • Pericholecystic fluid
  • Probe tenderness (ultrasonographic Murphy’s sign)

The ultrsound based diagnostic criteria from multiple studies for acalculous cholecystits is as follows.^[6]

Diagnosis: 2 major or 1 major and 2 minor (most studies have favored the diagnostic triad: wall thickness, sludge, hydrops).

• Advantages of ultrasound include:
  • Noninvasive
  • Quick and readily available
  • Relatively inexpensive

• Limitations of ultrasound include:
  • Poor visualization with intraluminal gas between probe and gallbladder