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Acute Acalculous Cholecystitis: A Review

Acute Acalculous Cholecystitis: A Review Acalculous Chobecystitis: Division, Palo Alto A Review. Medical Richard Clinic, Palo R. Babb, Alto, MD. CA Clin Gastroenterol 1992; 15:238-241. (Gas- troenterology 94301.) CUTE acalcubous flammation cholecystitis (AAC) is an acute inof the gallbladder with the absence of of different clinical disorders, the malities The criteria in patients that who signify had normal US examinations. are virtually abnormalities at CT gallstones. In a range combination therapy beads lead of fasting to bile state, shock, and various gallbladder, combination and secondary wall types and of identical to the findings at US-a thickened wall (greater than 3 mm) and a circumferential low-attenuation all patients with subserosal normal CT material. In one scans were later gallbladder layer of study proved cited, not decreased may infection. stasis, a distended blood flow. This unfortunate to gallbladder inflammation The result can be gallbladder necrosis and perforation AAC has tients who and, many are possibly, causes death of the patient. and most often occurs hospitalized in intensive in pacare already to have AAC, and of seven patients with abnormal findings, six were confirmed at surgical intervention to have AAC. The seventh patient improved without surgery, and the CT scan also returned to normal. The radiotracer technetium-99m cannot enter the gallbladder when acute gallbladder disease obstruction is present. The gallbladder in patients on treatment protocols that with cystic duct also is not imaged include paren- units trauma, shock and may be recovering burns. several from surgery, major or extensive and may have illnesses. have or both drome. Outpatients or may have with cardiovascular acquired They may underlying AAC tend disease, have experienced chronic medical to be elderly and hypertension, syn- teral nutrition, mechanical ventilation, many blood underlying immunodeficiency transfusions, in patients radiotracer and and or large doses of narcotics or antibiotics or who are fasting. In all of these patients, the cannot enter a flaccid, bile-fibbed gallbladder in the study results, diagbut Other of The tients impossible. upper liver diagnosis may present The of AAC of patients usual can be difficult. confusing and symptoms Critically complaints, ill pamay be right in numerous, signs examination quadrant function on life support systems of fever, produces a false-positive result. The use of radionuclide cholescintigraphy nosis of AAC has produced good results. found 13 of 24 patients had false-positive only one patient studies reported the To patients offset of 19 had a false-negative better correlations with One test pain, leukocytosis, test results, and sepsis mild abnormalities without obvious findultra- result. 90%-100% cause may not be apparent in many patients. Since a diagnosis of AAC on the basis of clinical ings may be questionable, the author recommends sound phy, (US), computed and a gallium who had abnormal possible false-positive may be administered scans also had AAC. results, intravenous if the patient’s gallblad- morphine tomography (CT), cholescintigraor indium leukocyte scan to image as the be performed as needed. first modality at the patient’s In patients be- der is not seen on the scan 40-60 minutes of the radionuclide. Morphine contracts after injection the sphincter of the gallbladder. US scanning is recommended can repeated it is noninvasive, and may be cause bedside, Oddi and forces more of the radiotracer into the gallbladder. This procedure was used in one study of 18 patients who were suspected to have cholecystitis but whose scintigram did not demonstrate the gallbladder. with wall AAC, US scans of greater than may show a thickened gallbladder 4-5 mm, dependent echogenic bile signify gallstones), gallbladder fluid without ascites, subseroin irregular, discontinuous, altersboughed mucosal membrane, In 17 patients, the gallbladder was demonstrated after morphine administration. The scintigram of the last patient again did not patient was found demonstrate to have AAC the gallbladder, at surgery. outside clue in the acute the gallbladder to perforation liver adjacent and the sludge (which also may distention, pericholecystic sal edema (particularly nating echogenic bands), Radionuclide extravasation indicates a perforation. Another increased activity of the tracer is to the sec- and the Murphy sign (where pressure from the US transducer over the gallbladder produces pain and tenderness). Studies have reported that US scans will be abnormab in 25%-100% of patients who have with All AAC. gallbladder fossa. This sign is not indicative from leukocyte of perfora- tion but may instead result ondary to severe inflammation. Gallium or indium-Ill a doughnut-shaped region, which of leukocytes in an perihepatitis scanning also The bladder diagnose author aspiration acute cites two studies where percutaneous US nine guidance patients gallto in may was gallbladder performed disease. help in the diagnosis of AAC. may One pattern have study reported on a one study had of three patients tis was confirmed abnormal US were positive at surgery other were tion. most study, found two of the to have an aspirate scans, and aspirate cultures for infection. Cholecystiin these patients. In the six patients who had AAC also scan with gallbladder uptake of uptake in the been secondary to gallbladder wall. inflammed culture technique aspirate the diagnosis positive for infecto be The US-guided helpful when aspiration the gallbladder with appears produces of AAC The three procedures used to treat a patient with AAC are cholecystectomy, surgical chobecystostomy, or percutaneous cholecystostomy. The decision on the best approach for any patient requires close cooperation between the internist, surgeon, and radiologist. Sus RSNA STEPAN Publications positive culture CT scanning difficult obogy results. may help patient scanning in cases. The unit, but CT must be transported may demonstrate to a radiabnor- #{149} Radiology April http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Radiology Radiological Society of North America, Inc.

Acute Acalculous Cholecystitis: A Review

SUSAN STEPAN
Radiology , Volume 191: 68 – Apr 1, 1994
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Radiological Society of North America, Inc.
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Copyright © April 1994 by Radiological Society of North America
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1527-1315
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0033-8419
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Abstract

Acalculous Chobecystitis: Division, Palo Alto A Review. Medical Richard Clinic, Palo R. Babb, Alto, MD. CA Clin Gastroenterol 1992; 15:238-241. (Gas- troenterology 94301.) CUTE acalcubous flammation cholecystitis (AAC) is an acute inof the gallbladder with the absence of of different clinical disorders, the malities The criteria in patients that who signify had normal US examinations. are virtually abnormalities at CT gallstones. In a range combination therapy beads lead of fasting to bile state, shock, and various gallbladder, combination and secondary wall types and of identical to the findings at US-a thickened wall (greater than 3 mm) and a circumferential low-attenuation all patients with subserosal normal CT material. In one scans were later gallbladder layer of study proved cited, not decreased may infection. stasis, a distended blood flow. This unfortunate to gallbladder inflammation The result can be gallbladder necrosis and perforation AAC has tients who and, many are possibly, causes death of the patient. and most often occurs hospitalized in intensive in pacare already to have AAC, and of seven patients with abnormal findings, six were confirmed at surgical intervention to have AAC. The seventh patient improved without surgery, and the CT scan also returned to normal. The radiotracer technetium-99m cannot enter the gallbladder when acute gallbladder disease obstruction is present. The gallbladder in patients on treatment protocols that with cystic duct also is not imaged include paren- units trauma, shock and may be recovering burns. several from surgery, major or extensive and may have illnesses. have or both drome. Outpatients or may have with cardiovascular acquired They may underlying AAC tend disease, have experienced chronic medical to be elderly and hypertension, syn- teral nutrition, mechanical ventilation, many blood underlying immunodeficiency transfusions, in patients radiotracer and and or large doses of narcotics or antibiotics or who are fasting. In all of these patients, the cannot enter a flaccid, bile-fibbed gallbladder in the study results, diagbut Other of The tients impossible. upper liver diagnosis may present The of AAC of patients usual can be difficult. confusing and symptoms Critically complaints, ill pamay be right in numerous, signs examination quadrant function on life support systems of fever, produces a false-positive result. The use of radionuclide cholescintigraphy nosis of AAC has produced good results. found 13 of 24 patients had false-positive only one patient studies reported the To patients offset of 19 had a false-negative better correlations with One test pain, leukocytosis, test results, and sepsis mild abnormalities without obvious findultra- result. 90%-100% cause may not be apparent in many patients. Since a diagnosis of AAC on the basis of clinical ings may be questionable, the author recommends sound phy, (US), computed and a gallium who had abnormal possible false-positive may be administered scans also had AAC. results, intravenous if the patient’s gallblad- morphine tomography (CT), cholescintigraor indium leukocyte scan to image as the be performed as needed. first modality at the patient’s In patients be- der is not seen on the scan 40-60 minutes of the radionuclide. Morphine contracts after injection the sphincter of the gallbladder. US scanning is recommended can repeated it is noninvasive, and may be cause bedside, Oddi and forces more of the radiotracer into the gallbladder. This procedure was used in one study of 18 patients who were suspected to have cholecystitis but whose scintigram did not demonstrate the gallbladder. with wall AAC, US scans of greater than may show a thickened gallbladder 4-5 mm, dependent echogenic bile signify gallstones), gallbladder fluid without ascites, subseroin irregular, discontinuous, altersboughed mucosal membrane, In 17 patients, the gallbladder was demonstrated after morphine administration. The scintigram of the last patient again did not patient was found demonstrate to have AAC the gallbladder, at surgery. outside clue in the acute the gallbladder to perforation liver adjacent and the sludge (which also may distention, pericholecystic sal edema (particularly nating echogenic bands), Radionuclide extravasation indicates a perforation. Another increased activity of the tracer is to the sec- and the Murphy sign (where pressure from the US transducer over the gallbladder produces pain and tenderness). Studies have reported that US scans will be abnormab in 25%-100% of patients who have with All AAC. gallbladder fossa. This sign is not indicative from leukocyte of perfora- tion but may instead result ondary to severe inflammation. Gallium or indium-Ill a doughnut-shaped region, which of leukocytes in an perihepatitis scanning also The bladder diagnose author aspiration acute cites two studies where percutaneous US nine guidance patients gallto in may was gallbladder performed disease. help in the diagnosis of AAC. may One pattern have study reported on a one study had of three patients tis was confirmed abnormal US were positive at surgery other were tion. most study, found two of the to have an aspirate scans, and aspirate cultures for infection. Cholecystiin these patients. In the six patients who had AAC also scan with gallbladder uptake of uptake in the been secondary to gallbladder wall. inflammed culture technique aspirate the diagnosis positive for infecto be The US-guided helpful when aspiration the gallbladder with appears produces of AAC The three procedures used to treat a patient with AAC are cholecystectomy, surgical chobecystostomy, or percutaneous cholecystostomy. The decision on the best approach for any patient requires close cooperation between the internist, surgeon, and radiologist. Sus RSNA STEPAN Publications positive culture CT scanning difficult obogy results. may help patient scanning in cases. The unit, but CT must be transported may demonstrate to a radiabnor- #{149} Radiology April

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Published: Apr 1, 1994

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