Acute cholecystitis accounts for ab...

Acute cholecystitis accounts for about 9 percent of hospital admissions for acute abdominal pain. Because the clinical presentation of cholecystitis may be inconsistent, sonographic findings of the like kind as visualization of stones, measurement of gall bladder wall thickness, and gallbladder distention commonly are used in making the diagnosis. Bingener and colleagues studied the correlation of specific ultrasonographic findings with the diagnosis at surgery in patients with suspected cholecystitis.

They studied patients admitted to a university hospital because of suspected acute cholecystitis. Eligible patients had significant constant upper right quadrant pain, excitement nausea, vomiting, and elevated white descendants cell counts. Diagnostic ultrasound images were independently reviewed by means of two radiologists before the patients underwent laparoscopic cholecystectomy. Surgery was performed within 48 hours, and the surgical and histologic findings were compared with the ultrasonography results

The mean age of the 47 women and eight men in the application of mind was 37 years. The correlation of ultrasonography and surgical findings was strongest with the air of gallstones (see accompanying table). False-positive deductions for gallstones occurred in three patients (55 percent) and a false-negative end occurred in one patient (18 percent) The overall sensitivity for the appearance of stones was 98 percent Although ultrasonography predicted the same stone in seven patients, a solitary stone was set at surgery in five cases and in 12 histologic specimens. Ultrasonography was a poor predictor of hydrop or strictly distended gallbladder. At surgery, 17 patients had strict hydrops, and 26 showed

some standing of hydrops, but only four cases were anticipated based forward the sonogram. Similarly, ultrasound imaging sole moderately predicted gallbladder wall thickening. Correlation with wall thickness at pathology was complicated through specimen dehydration in formaldehyde. Overall, ultrasound examination diagnosed 24 patients as having acute cholecystitis; further at surgery, 15 patients had accurate inflammation, nine had moderate inflammation, and 16 had early inflammatory changes. This correlates with a sensitivity of 60 percent if a sonographic Murphy's sign was reported (pain when the ultrasound probe was passed through the whole extent of the gallbladder) and a sensitivity of 54 percent if the radiologist was not aware of this finding. The specificity for acute cholecystitis diagnosed in succession ultrasound examination was 77 percent compared with surgical findings and 71 percent compared with histology.

The authors determine that ultrasonography has limited ability to predict acute cholecystitis, yet that it is highly sensitive in the detection of gallstones.

ANNE D WALLING, MD

Bingener J et al. Does the correlation of acute cholecystitis upon ultrasound and at surgery meditate a mirror image? Am J Surg December 2004;188:703-7

COPYRIGHT 2005 American Academy of Family Physicians

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