Complicated cholecystitis: the complementary roles of sonography and computed tomography

Area of Science:

• Radiology
• Gastroenterology
• Abdominal Imaging

Background:

• Acute cholecystitis is a frequent cause of abdominal pain.
• Complicated cholecystitis (gangrenous, perforated, emphysematous) increases morbidity and mortality.
• Early diagnosis and treatment are vital for optimal patient outcomes.

Purpose of the Study:

• To highlight the challenges in diagnosing complicated cholecystitis with cross-sectional imaging.
• To review key sonographic and computed tomography (CT) findings indicative of complicated cholecystitis.
• To emphasize the role of imaging in guiding treatment decisions.

Main Methods:

• Review of sonographic and CT imaging findings in complicated cholecystitis.
• Identification of specific imaging features associated with complications.
• Discussion of the complementary roles of sonography and CT.

Main Results:

• Worrisome imaging findings include intraluminal abnormalities (sloughed mucosa, hemorrhage, gas), gallbladder wall changes (thickening, gas, altered reflectivity), and pericholecystic alterations (fat, fluid, abscess).
• Sonography and CT can reveal specific signs of gallbladder wall compromise and surrounding inflammation.
• Imaging findings can predict the severity and guide management strategies.

Conclusions:

• Radiologists must be adept at interpreting imaging for complicated cholecystitis.
• Sonography and CT are essential tools for diagnosis and management planning.
• Accurate imaging facilitates timely and appropriate interventions, including minimally invasive options.