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Gangrenous cholecystitis: new observations on sonography
S A Teefey1, R L Baron, H M Radke
1Department of Radiology, University of Washington School of Medicine, Seattle.
Summary
Gangrenous cholecystitis may be identified by a new sonographic finding: striated gallbladder wall thickening. This finding, along with specific pericholecystic fluid patterns, can indicate gallbladder perforation and abscess formation.
Area of Science:
- Radiology
- Gastroenterology
- Surgical Pathology
Background:
- Gangrenous cholecystitis is a severe form of acute cholecystitis.
- Accurate diagnosis is crucial for timely surgical intervention.
- Previous sonographic findings for gangrenous cholecystitis lack consistent sensitivity.
Purpose of the Study:
- To identify novel sonographic findings associated with gangrenous cholecystitis.
- To characterize patterns of pericholecystic fluid collections in gangrenous cholecystitis.
- To evaluate the diagnostic utility of sonographic findings in predicting gallbladder complications.
Main Methods:
- Retrospective analysis of 25 patients diagnosed with gangrenous cholecystitis.
- Detailed sonographic evaluation of gallbladder wall morphology and pericholecystic fluid.
- Comparison of sonographic findings with previously reported features.
Main Results:
- A novel sonographic finding of "striated thickening" of the gallbladder wall was observed in 10 of 25 patients.
- Striated thickening, characterized by alternating hypoechoic and hyperechoic layers, was more frequent than intraluminal membranes or mass-like protrusions.
- Two subtypes of pericholecystic fluid collections (types II and III) were more frequently associated with gallbladder perforation and abscess formation compared to type I.
Conclusions:
- Striated gallbladder wall thickening on ultrasound is a significant finding that should prompt consideration of gangrenous changes in acute cholecystitis.
- Specific patterns of pericholecystic fluid collections may predict the risk of gallbladder perforation and abscess formation.
- These sonographic findings can aid in the early diagnosis and management of severe cholecystitis.