Role of Ultrasonography in Diagnosis of Acute Cholecystitis

Abstract

Acute cholecystitis (AC) is a common clinical problem. Accurate and prompt diagnosis is essential to minimize mortality and morbidity. To establish a reliable diagnosis, many fators need to be present, e.g. patients with clinical symptoms and signs of Right Upper Quadrant (RUQ) pain, Murphy’s sign, fever, jaundice, laboratory findings (disturbed liver function and lecucytosis) , and finaly radiological diagnostic methods like CT scan, MRI, cholescintigraphy and ultrasonography (US ) that is the chosen modality in this study.

The purpose of this research is to assess the role of ultrasound ( US ) in diagnosis of acute cholecystitis. The study’s target is the patients who presented in the Accident and Emergency department (A&E ) with the classical symptoms and signs of Acute Cholecystitis. Abdominal ultrasonography is a none invasive, affordable and most importantly a bed-side method of diagnosing AC.

In this study, we reviewed the gross and sonographic anatomy of the gallbladder, pathology of acute cholecystitis, clinical, laboratory, and radiological (specifically ultrasongraphic) findings of acute cholecystitis are elaborated on. The complications and differential diagnosis of acute cholecystitis are reviewed as well. Two hundreds and fifty patients with clinicaly suspected acute cholecystitis were randomized into two groups. The first group included those patients with final diagnosis of acute cholecystitis and the other group included those patients with final alternative diagnosis to acute cholecystitis. US accurately diagnosed (US – based true-positive) 164 patients (94%) out of 175 patients with final diagnosis of AC including accurate diagnosis of 142 patients from 149 patients (95.2%) with final diagnosis of acute non-complicated acute cholecystitis and 22 patients from 26 patients (84.6%) with final diagnosis of complicated acute cholecystitis . In addition US diagnosed many cases with alternative diagnosis to acute cholecystitis. We discussed our results, and found that ultrasound (US ) was of great value in increasing accuracy in diagnosing of acute cholecystitis, and it decreases the false negative diagnogtic rate and improved the clinical outcome. We illustrated 21 representative cases done in our study with brief report summary. We recommend application of the