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Acute Calculous Cholecystitis
Siva P. Raman, MD
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KEY FACTS

  • Terminology

    • Imaging

      • Top Differential Diagnoses

        • Clinical Issues

          TERMINOLOGY

          • Definitions

            • Acute inflammation of gallbladder (GB) precipitated by an obstructing calculus within GB neck or cystic duct

          IMAGING

          • General Features

            • Fluoroscopic Findings

              • CT Findings

                • MR Findings

                  • Ultrasonographic Findings

                    • Nuclear Medicine Findings

                      • Imaging Recommendations

                        DIFFERENTIAL DIAGNOSIS

                          PATHOLOGY

                          • General Features

                            • Staging, Grading, & Classification

                              • Gross Pathologic & Surgical Features

                                • Microscopic Features

                                  CLINICAL ISSUES

                                  • Presentation

                                    • Demographics

                                      • Natural History & Prognosis

                                        • Treatment

                                          DIAGNOSTIC CHECKLIST

                                          • Consider

                                            • Image Interpretation Pearls

                                              Selected References

                                              1. Atar E et al: Percutaneous cholecystostomy in critically ill patients with acute cholecystitis: complications and late outcome. Clin Radiol. 69(6):e247-52, 2014
                                              2. Choi IY et al: Diagnosis of acute cholecystitis: value of contrast agent in the gallbladder and cystic duct on Gd-EOB-DTPA enhanced MR cholangiography. Clin Imaging. 38(2):174-8, 2014
                                              3. Seyal AR et al: Cross-sectional imaging of perforated gallbladder. Abdom Imaging. 39(4):853-74, 2014
                                              4. Yacoub JH et al: Evaluation of the gallbladder and cystic duct patency with gadoxetate disodium enhanced MR cholangiography: prospective comparison of patients with normal gallbladder function and acute cholecystitis. Acta Radiol. ePub, 2014
                                              5. Ziessman HA: Hepatobiliary Scintigraphy in 2014. J Nucl Med. 55(6):967-975, 2014
                                              6. Kaura SH et al: Comparison of CT and MRI findings in the differentiation of acute from chronic cholecystitis. Clin Imaging. 37(4):687-91, 2013
                                              7. Patel NB et al: Multidetector CT of emergent biliary pathologic conditions. Radiographics. 33(7):1867-88, 2013
                                              8. Pinto A et al: Accuracy of ultrasonography in the diagnosis of acute calculous cholecystitis: review of the literature. Crit Ultrasound J. 5 Suppl 1:S11, 2013
                                              9. Soyer P et al: Acute cholecystitis: quantitative and qualitative evaluation with 64-section helical CT. Acta Radiol. 54(5):477-486, 2013
                                              10. Teefey SA et al: Acute cholecystitis: do sonographic findings and WBC count predict gangrenous changes? AJR Am J Roentgenol. 200(2):363-9, 2013
                                              11. Fuks D et al: Acute cholecystitis: preoperative CT can help the surgeon consider conversion from laparoscopic to open cholecystectomy. Radiology. 263(1):128-38, 2012
                                              12. Tonolini M et al: Urgent MRI with MR cholangiopancreatography (MRCP) of acute cholecystitis and related complications: diagnostic role and spectrum of imaging findings. Emerg Radiol. 19(4):341-8, 2012
                                              13. Tavernaraki K et al: Massive intraperitoneal bleeding due to hemorrhagic cholecystitis and gallbladder rupture: CT findings. Abdom Imaging. 36(5):565-8, 2011
                                              14. Shakespear JS et al: CT findings of acute cholecystitis and its complications. AJR Am J Roentgenol. 194(6):1523-9, 2010
                                              15. Elsayes KM et al: Gastrointestinal manifestations of diabetes mellitus: spectrum of imaging findings. J Comput Assist Tomogr. 33(1):86-9, 2009
                                              16. Kim HO et al: Impact of delayed laparoscopic cholecystectomy after percutaneous transhepatic gallbladder drainage for patients with complicated acute cholecystitis. Surg Laparosc Endosc Percutan Tech. 19(1):20-4, 2009
                                              17. Smith EA et al: Cross-sectional imaging of acute and chronic gallbladder inflammatory disease. AJR Am J Roentgenol. 192(1):188-96, 2009
                                              18. Walton TJ et al: Imaging after medically managed severe acute cholecystitis. Gut. 58(3):421, 472, 2009
                                              19. Ziessman HA: Interventions used with cholescintigraphy for the diagnosis of hepatobiliary disease. Semin Nucl Med. 39(3):174-85, 2009
                                              20. Catalano OA et al: MR imaging of the gallbladder: a pictorial essay. Radiographics. 28(1):135-55; quiz 324, 2008
                                              21. Ha JP et al: Cholecystectomy or not after percutaneous cholecystostomy for acute calculous cholecystitis in high-risk patients. Hepatogastroenterology. 55(86-87):1497-502, 2008
                                              22. Barie PS et al: Acute acalculous cholecystitis. Curr Gastroenterol Rep. 5(4):302-9, 2003
                                              23. Bennett GL et al: Ultrasound and CT evaluation of emergent gallbladder pathology. Radiol Clin North Am. 41(6):1203-16, 2003
                                              24. Browning JD et al: Gallstone disease and its complications. Semin Gastrointest Dis. 14(4):165-77, 2003
                                              25. Cheema S et al: Timing of laparoscopic cholecystectomy in acute cholecystitis. Ir J Med Sci. 172(3):128-31, 2003
                                              26. Fayad LM et al: Functional magnetic resonance cholangiography (fMRC) of the gallbladder and biliary tree with contrast-enhanced magnetic resonance cholangiography. J Magn Reson Imaging. 18(4):449-60, 2003
                                              27. Gandolfi L et al: The role of ultrasound in biliary and pancreatic diseases. Eur J Ultrasound. 16(3):141-59, 2003
                                              28. Kim KW et al: Acute cholecystitis at T2-weighted and manganese-enhanced T1-weighted MR cholangiography: preliminary study. Radiology. 227(2):580-4, 2003
                                              29. Ko CW et al: Gastrointestinal disorders of the critically ill. Biliary sludge and cholecystitis. Best Pract Res Clin Gastroenterol. 17(3):383-96, 2003
                                              30. Oh KY et al: Limited abdominal MRI in the evaluation of acute right upper quadrant pain. Abdom Imaging. 28(5):643-51, 2003
                                              31. Ozaras R et al: Acute viral cholecystitis due to hepatitis A virus infection. J Clin Gastroenterol. 37(1):79-81, 2003
                                              32. Pazzi P et al: Biliary sludge: the sluggish gallbladder. Dig Liver Dis. 35 Suppl 3:S39-45, 2003
                                              33. Pedrosa I et al: The interrupted rim sign in acute cholecystitis: a method to identify the gangrenous form with MRI. J Magn Reson Imaging. 18(3):360-3, 2003
                                              34. Roth T et al: Acute acalculous cholecystitis associated with aortic dissection: report of a case. Surg Today. 33(8):633-5, 2003
                                              35. Trowbridge RL et al: Does this patient have acute cholecystitis? JAMA. 289(1):80-6, 2003
                                              36. Yusoff IF et al: Diagnosis and management of cholecystitis and cholangitis. Gastroenterol Clin North Am. 32(4):1145-68, 2003
                                              37. Abou-Saif A et al: Complications of gallstone disease: Mirizzi syndrome, cholecystocholedochal fistula, and gallstone ileus. Am J Gastroenterol. 97(2):249-54, 2002
                                              38. Adusumilli S et al: MR imaging of the gallbladder. Magn Reson Imaging Clin N Am. 10(1):165-84, 2002
                                              39. Bingener-Casey J et al: Reasons for conversion from laparoscopic to open cholecystectomy: a 10-year review. J Gastrointest Surg. 6(6):800-5, 2002
                                              40. Gore RM et al: Imaging benign and malignant disease of the gallbladder. Radiol Clin North Am. 40(6):1307-23, vi, 2002
                                              41. Indar AA et al: Acute cholecystitis. BMJ. 325(7365):639-43, 2002
                                              42. Kitano S et al: Laparoscopic cholecystectomy for acute cholecystitis. J Hepatobiliary Pancreat Surg. 9(5):534-7, 2002
                                              43. Draghi F et al: Power Doppler ultrasound of gallbladder wall vascularization in inflammation: clinical implications. Eur Radiol. 10(10):1587-90, 2000
                                              44. Park MS et al: Acute cholecystitis: comparison of MR cholangiography and US. Radiology. 209(3):781-5, 1998
                                              Related Anatomy
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                                              Related Differential Diagnoses
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                                              References
                                              Tables

                                              Tables

                                              KEY FACTS

                                              • Terminology

                                                • Imaging

                                                  • Top Differential Diagnoses

                                                    • Clinical Issues

                                                      TERMINOLOGY

                                                      • Definitions

                                                        • Acute inflammation of gallbladder (GB) precipitated by an obstructing calculus within GB neck or cystic duct

                                                      IMAGING

                                                      • General Features

                                                        • Fluoroscopic Findings

                                                          • CT Findings

                                                            • MR Findings

                                                              • Ultrasonographic Findings

                                                                • Nuclear Medicine Findings

                                                                  • Imaging Recommendations

                                                                    DIFFERENTIAL DIAGNOSIS

                                                                      PATHOLOGY

                                                                      • General Features

                                                                        • Staging, Grading, & Classification

                                                                          • Gross Pathologic & Surgical Features

                                                                            • Microscopic Features

                                                                              CLINICAL ISSUES

                                                                              • Presentation

                                                                                • Demographics

                                                                                  • Natural History & Prognosis

                                                                                    • Treatment

                                                                                      DIAGNOSTIC CHECKLIST

                                                                                      • Consider

                                                                                        • Image Interpretation Pearls

                                                                                          Selected References

                                                                                          1. Atar E et al: Percutaneous cholecystostomy in critically ill patients with acute cholecystitis: complications and late outcome. Clin Radiol. 69(6):e247-52, 2014
                                                                                          2. Choi IY et al: Diagnosis of acute cholecystitis: value of contrast agent in the gallbladder and cystic duct on Gd-EOB-DTPA enhanced MR cholangiography. Clin Imaging. 38(2):174-8, 2014
                                                                                          3. Seyal AR et al: Cross-sectional imaging of perforated gallbladder. Abdom Imaging. 39(4):853-74, 2014
                                                                                          4. Yacoub JH et al: Evaluation of the gallbladder and cystic duct patency with gadoxetate disodium enhanced MR cholangiography: prospective comparison of patients with normal gallbladder function and acute cholecystitis. Acta Radiol. ePub, 2014
                                                                                          5. Ziessman HA: Hepatobiliary Scintigraphy in 2014. J Nucl Med. 55(6):967-975, 2014
                                                                                          6. Kaura SH et al: Comparison of CT and MRI findings in the differentiation of acute from chronic cholecystitis. Clin Imaging. 37(4):687-91, 2013
                                                                                          7. Patel NB et al: Multidetector CT of emergent biliary pathologic conditions. Radiographics. 33(7):1867-88, 2013
                                                                                          8. Pinto A et al: Accuracy of ultrasonography in the diagnosis of acute calculous cholecystitis: review of the literature. Crit Ultrasound J. 5 Suppl 1:S11, 2013
                                                                                          9. Soyer P et al: Acute cholecystitis: quantitative and qualitative evaluation with 64-section helical CT. Acta Radiol. 54(5):477-486, 2013
                                                                                          10. Teefey SA et al: Acute cholecystitis: do sonographic findings and WBC count predict gangrenous changes? AJR Am J Roentgenol. 200(2):363-9, 2013
                                                                                          11. Fuks D et al: Acute cholecystitis: preoperative CT can help the surgeon consider conversion from laparoscopic to open cholecystectomy. Radiology. 263(1):128-38, 2012
                                                                                          12. Tonolini M et al: Urgent MRI with MR cholangiopancreatography (MRCP) of acute cholecystitis and related complications: diagnostic role and spectrum of imaging findings. Emerg Radiol. 19(4):341-8, 2012
                                                                                          13. Tavernaraki K et al: Massive intraperitoneal bleeding due to hemorrhagic cholecystitis and gallbladder rupture: CT findings. Abdom Imaging. 36(5):565-8, 2011
                                                                                          14. Shakespear JS et al: CT findings of acute cholecystitis and its complications. AJR Am J Roentgenol. 194(6):1523-9, 2010
                                                                                          15. Elsayes KM et al: Gastrointestinal manifestations of diabetes mellitus: spectrum of imaging findings. J Comput Assist Tomogr. 33(1):86-9, 2009
                                                                                          16. Kim HO et al: Impact of delayed laparoscopic cholecystectomy after percutaneous transhepatic gallbladder drainage for patients with complicated acute cholecystitis. Surg Laparosc Endosc Percutan Tech. 19(1):20-4, 2009
                                                                                          17. Smith EA et al: Cross-sectional imaging of acute and chronic gallbladder inflammatory disease. AJR Am J Roentgenol. 192(1):188-96, 2009
                                                                                          18. Walton TJ et al: Imaging after medically managed severe acute cholecystitis. Gut. 58(3):421, 472, 2009
                                                                                          19. Ziessman HA: Interventions used with cholescintigraphy for the diagnosis of hepatobiliary disease. Semin Nucl Med. 39(3):174-85, 2009
                                                                                          20. Catalano OA et al: MR imaging of the gallbladder: a pictorial essay. Radiographics. 28(1):135-55; quiz 324, 2008
                                                                                          21. Ha JP et al: Cholecystectomy or not after percutaneous cholecystostomy for acute calculous cholecystitis in high-risk patients. Hepatogastroenterology. 55(86-87):1497-502, 2008
                                                                                          22. Barie PS et al: Acute acalculous cholecystitis. Curr Gastroenterol Rep. 5(4):302-9, 2003
                                                                                          23. Bennett GL et al: Ultrasound and CT evaluation of emergent gallbladder pathology. Radiol Clin North Am. 41(6):1203-16, 2003
                                                                                          24. Browning JD et al: Gallstone disease and its complications. Semin Gastrointest Dis. 14(4):165-77, 2003
                                                                                          25. Cheema S et al: Timing of laparoscopic cholecystectomy in acute cholecystitis. Ir J Med Sci. 172(3):128-31, 2003
                                                                                          26. Fayad LM et al: Functional magnetic resonance cholangiography (fMRC) of the gallbladder and biliary tree with contrast-enhanced magnetic resonance cholangiography. J Magn Reson Imaging. 18(4):449-60, 2003
                                                                                          27. Gandolfi L et al: The role of ultrasound in biliary and pancreatic diseases. Eur J Ultrasound. 16(3):141-59, 2003
                                                                                          28. Kim KW et al: Acute cholecystitis at T2-weighted and manganese-enhanced T1-weighted MR cholangiography: preliminary study. Radiology. 227(2):580-4, 2003
                                                                                          29. Ko CW et al: Gastrointestinal disorders of the critically ill. Biliary sludge and cholecystitis. Best Pract Res Clin Gastroenterol. 17(3):383-96, 2003
                                                                                          30. Oh KY et al: Limited abdominal MRI in the evaluation of acute right upper quadrant pain. Abdom Imaging. 28(5):643-51, 2003
                                                                                          31. Ozaras R et al: Acute viral cholecystitis due to hepatitis A virus infection. J Clin Gastroenterol. 37(1):79-81, 2003
                                                                                          32. Pazzi P et al: Biliary sludge: the sluggish gallbladder. Dig Liver Dis. 35 Suppl 3:S39-45, 2003
                                                                                          33. Pedrosa I et al: The interrupted rim sign in acute cholecystitis: a method to identify the gangrenous form with MRI. J Magn Reson Imaging. 18(3):360-3, 2003
                                                                                          34. Roth T et al: Acute acalculous cholecystitis associated with aortic dissection: report of a case. Surg Today. 33(8):633-5, 2003
                                                                                          35. Trowbridge RL et al: Does this patient have acute cholecystitis? JAMA. 289(1):80-6, 2003
                                                                                          36. Yusoff IF et al: Diagnosis and management of cholecystitis and cholangitis. Gastroenterol Clin North Am. 32(4):1145-68, 2003
                                                                                          37. Abou-Saif A et al: Complications of gallstone disease: Mirizzi syndrome, cholecystocholedochal fistula, and gallstone ileus. Am J Gastroenterol. 97(2):249-54, 2002
                                                                                          38. Adusumilli S et al: MR imaging of the gallbladder. Magn Reson Imaging Clin N Am. 10(1):165-84, 2002
                                                                                          39. Bingener-Casey J et al: Reasons for conversion from laparoscopic to open cholecystectomy: a 10-year review. J Gastrointest Surg. 6(6):800-5, 2002
                                                                                          40. Gore RM et al: Imaging benign and malignant disease of the gallbladder. Radiol Clin North Am. 40(6):1307-23, vi, 2002
                                                                                          41. Indar AA et al: Acute cholecystitis. BMJ. 325(7365):639-43, 2002
                                                                                          42. Kitano S et al: Laparoscopic cholecystectomy for acute cholecystitis. J Hepatobiliary Pancreat Surg. 9(5):534-7, 2002
                                                                                          43. Draghi F et al: Power Doppler ultrasound of gallbladder wall vascularization in inflammation: clinical implications. Eur Radiol. 10(10):1587-90, 2000
                                                                                          44. Park MS et al: Acute cholecystitis: comparison of MR cholangiography and US. Radiology. 209(3):781-5, 1998