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The changing face of emphysematous cholecystitis
K S Gill1, A H Chapman, M J Weston
1Department of Radiology, St James's University Hospital, Leeds, UK.
The British Journal of Radiology
|December 24, 1997
Summary
Emphysematous cholecystitis, a gallbladder condition with gas, is often missed by plain abdominal X-rays. Ultrasound and CT scans improve diagnosis, allowing for conservative management in many mild cases.
Area of Science:
- Gastroenterology
- Radiology
- Surgical Pathology
Background:
- Emphysematous cholecystitis (EC) is a rare variant of acute cholecystitis.
- Characterized by gas in the gallbladder wall, lumen, or pericholecystic tissues.
- Traditionally diagnosed via plain abdominal radiography (AXR), often leading to delayed or missed diagnoses.
Purpose of the Study:
- To evaluate the diagnostic accuracy of imaging modalities for EC.
- To assess the clinical presentation and management outcomes of EC patients.
- To determine if conservative management is feasible for certain EC cases.
Main Methods:
- Retrospective review of eight EC cases over five years.
- Analysis of diagnostic performance of plain abdominal radiography (AXR), ultrasound (US), and computed tomography (CT).
- Evaluation of clinical findings, management strategies (conservative vs. cholecystectomy), and patient outcomes.
Main Results:
- AXR diagnosed only one of eight EC cases.
- Ultrasound (US) correctly identified five cases, but failed to visualize the gallbladder in three.
- CT scans were crucial for diagnosing EC in three cases where US was negative; conservative management was successful in five patients.
Conclusions:
- Plain abdominal radiography (AXR) is insensitive for diagnosing emphysematous cholecystitis.
- Increased frequency of EC diagnosis is attributed to routine US use in hepatobiliary disease.
- Conservative management is a viable option for a significant proportion of EC patients based on clinical assessment.