At the Viewbox: Acute Cholecystitis

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A 54-year-old man presented with diffuse abdominal pain and sepsis. A longitudinal sonographic image of the gallbladder (A) demonstrates gallbladder wall thickening with edema, pericholecystic fluid, gallbladder distention, and layering sludge with gallstones. Axial noncontrast CT image (B) shows marked pericholecystic inflammatory changes.

Gallbladder wall thickening is a nonspecific imaging finding with a multitude of potential etiologies. Acute cholecystitis is the most common cause with 2 variants described: calculus and acalculus. Calculus cholecystitis results from an obstructing stone with subsequent bile stasis and overgrowth of bacteria, whereas acalculus cholecystitis occurs secondary to increased viscosity of bile in critically ill, fasting patients. In addition to the imaging findings described above, elicitation of a sonographic Murphy's sign, particularly in calculus cholecystitis, is helpful in establishing the diagnosis. If left untreated, cholecystitis can result in necrosis with gangrenous changes or emphysema if gas-forming organisms are present. These complications have a higher risk of gallbladder rupture and increased mortality.1

CT can evaluate for such complications of acute cholecystitis and may also assist in evaluation of other etiologies of gallbladder wall thickening if the clinical presentation is nebulous. Nuclear medicine cholescintigraphy is helpful in distinguishing acute from chronic cholecystitis. Endoscopic retrograde cholangiopancreatography (ERCP) or magnetic resonance cholangiopancreatography (MRCP) may detect choledocholithiasis.

Patients with acute cholecystitis are treated with cholecystectomy, or percutaneous transhepatic cholecystostomy tube in poor surgical candidates.


  1. O'Connor OJ, Maher MM. Imaging of cholecystitis. Am J Roentgenol 2011;196: W367-W374.
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Luu N, McKnight T.  At the Viewbox: Acute Cholecystitis.  J Am Osteopath Coll Radiol.  2016;5(2):30.

About the Author

Ngoc Luu, D.O., Timothy McKnight, D.O.

Ngoc Luu, D.O., Timothy McKnight, D.O.

Ngoc Luu, D.O. and Timothy McKnight, D.O. are with the Department of Radiology, Botsford Hospital, Farmington Hills, MI


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