Diagnostic ultrasound ( PDFDrive )

196 PART II Abdominal and Pelvic Sonography
A
B
C
D
FIG. 6.38 Tumefactive Sludge in Three Patients. (A) Sagittal sonogram shows gallbladder illed with tumorlike sludge. (B) Transverse image
shows a polypoid appearance of sludge on the dependent gallbladder wall, with an embedded stone (note shadowing). (C) Sagittal and (D) subcostal
oblique sonograms of the same patient show “hepatization” of the gallbladder, with internal echoes mimicking the normal liver parenchyma. In all
three patients the gallbladder wall was normal. There was no vascularity detected from the tumefactive sludge.
and eventually necrosis of the gallbladder. In the under-50 age
group, women are afected three times more oten than men,
although incidence of acute cholecystitis is similar in older age
groups. 76 However, cholecystitis tends to be more severe in men. 81
Clinically, patients experience prolonged, constant RUQ or
epigastric pain associated with RUQ tenderness. Fever, leukocytosis,
and increased serum alkaline phosphatase and bilirubin
levels may be present.
Sonography is currently the most practical and accurate
method to diagnose acute cholecystitis (Figs. 6.39 and 6.40, Video
6.10). When adjusted for veriication bias, sensitivity and speciicity
of ultrasound are approximately 88% and 80%, respectively. 82
Cholescintigraphy uses ionizing radiation, cannot be performed
at the bedside, and also has a signiicant false-positive rate.
Although less accurate than sonography in the diagnosis of acute
cholecystitis, CT may be useful for depiction of complications. 83
Sonographic indings include the following 84 (Table 6.1):
• hickening of the gallbladder wall (>3 mm)
• Distention of the gallbladder lumen (diameter > 4 cm)
• Gallstones
• Impacted stone in cystic duct or gallbladder neck
• Pericholecystic luid collections
• Positive sonographic Murphy sign
• Hyperemic gallbladder wall on Doppler interrogation