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Acute cholecystitis: do sonographic findings and WBC count predict gangrenous changes?
Sharlene A Teefey1, Nirvikar Dahiya, William D Middleton
1Mallinckrodt Institute of Radiology, Washington University School of Medicine, 510 S Kingshighway Blvd, St. Louis, MO 63110, USA. teefeys@mir.wustl.edu
AJR. American Journal of Roentgenology
|January 25, 2013
Summary
Gallbladder wall thickening and elevated white blood cell (WBC) counts indicate gangrenous cholecystitis, but with overlap. Wall striations and a negative Murphy sign do not reliably predict this severe condition.
Area of Science:
- Gastroenterology
- Diagnostic Imaging
- Surgical Pathology
Background:
- Acute cholecystitis is inflammation of the gallbladder.
- Gangrenous cholecystitis represents a severe progression requiring prompt surgical intervention.
- Accurate preoperative diagnosis is crucial for patient management.
Purpose of the Study:
- To investigate the association between gallbladder wall striations on ultrasound and gangrenous changes.
- To determine if white blood cell (WBC) count or other sonographic findings correlate with gangrenous cholecystitis.
Main Methods:
- Retrospective review of 68 patients undergoing cholecystectomy post-ultrasound.
- Analysis of sonographic findings (wall thickness, striations, Murphy sign, etc.).
- Correlation of imaging findings with WBC counts and histopathologic diagnoses.
Main Results:
- Gallbladder wall thickening and higher WBC counts were significantly associated with gangrenous cholecystitis.
- Wall striations and a negative Murphy sign showed no association with gangrenous changes.
- Considerable overlap in findings existed between gangrenous and non-gangrenous groups.
Conclusions:
- While gallbladder wall thickening and elevated WBC counts suggest gangrenous cholecystitis, they are not definitive.
- Sonographic wall striations and a negative Murphy sign are unreliable indicators of gangrenous cholecystitis.
- Further research may refine diagnostic criteria for severe acute cholecystitis.
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