Up to 95% of cholecystitis involves stones. US • Gallstones and gallbladder wall >3 mm thick is most sensitive. • Markedly distended ...
Up to 95% of cholecystitis involves stones.
US
• Gallstones and gallbladder wall >3 mm thick is most sensitive.
• Markedly distended gall bladder (>5 cm), pericholecystic fluid, wall hyperaemia and wall striations are suggestive.
CT
• Intramural or intracystic gas suggests gangrenous cholecystitis or emphysematous cholecystitis.
• Up to 10% of gallbladders perforate with acute cholecystitis.
• Up to 10% of gallbladders perforate with acute cholecystitis.
NUCLEAR MEDICINE
• Hepatic iminodiacetic acid (HIDA) scan: technetium-99m-labelled bilirubin analogue given intravenously; images then gathered over the next 2-4 hours.
• Passage of isotope: liver — bile ducts — gallbladder and duodenum — small bowel.
• Needs gallbladder to be present and cystic duct to be patent.
• Non-visualisation of the gallbladder at 4 hours is diagnostic (i.e. cystic duct is obstructed).
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