Acute cholecystitis echocardiography and ultrasound

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Acute cholecystitis Microchapters


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Differentiating Acute cholecystitis from other Diseases

Epidemiology and Demographics

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Natural History, Complications and Prognosis


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Physical Examination

Laboratory Findings



Echocardiography and Ultrasound

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Case #1

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Furqan M M. M.B.B.S[2]


Transabdominal ultrasound is the initial test of choice for the diagnosis of acute cholecystitis. Findings on an ultrasound diagnostic of acute cholecystitis include thickened gallbladder, gallstones or sludge, and pericholecystic fluid.


  • Transabdominal ultrasonography is the initial test of choice for the diagnosis of acute cholecystitis and gallstones.[1][2][3][4][5]
    • Findings on an transabdominal ultrasonography diagnostic of acute cholecystitis include:
    • Acalculous cholecystitis may only show a distended gallbladder

Calculous Cholecystitis

  • Acute calculous cholecystitis is diagnosed radiologically by the presence of
    • Thickening of gallbladder (5mm or greater)
    • Pericholecystic fluid
    • Probe tenderness (ultrasonographic Murphy's sign)

Acalculous Cholecystitis

The ultrsound based diagnostic criteria from multiple studies for acalculous cholecystits is as follows.[6]

Criteria Diagnosis
Major 3.5 to 4 mm (or more) thick wall (if at least 5 cm distended longitudinally with no ascites or hypoalbuminemia)
Pericholecystic fluid (halo)/subserosal edema
Intramural gas
Sloughed mucosal membrane
Minor Echogenic bile (sludge)
Hydrops = distension greater than 8-cm longitudinally or 5-cm transversely (with clear fluid)

Diagnosis: 2 major or 1 major and 2 minor (most studies have favored the diagnostic triad: wall thickness, sludge, hydrops).

Advantages of ultrasound

  • Advantages of ultrasound include:
    • Noninvasive
    • Quick and readily available
    • Relatively inexpensive

Limitations of ultrasound

  • Limitations of ultrasound include:
    • Poor visualization with intraluminal gas between probe and gallbladder
USG of acute cholecystitis; Red arrow shows gallstone and yellow arrow shows gallblader wall thickening. Case courtesy of Dr Maulik S Patel,, rID: 20542 Source:[7]


  1. "Gallbladder, Cholecystitis, Acute - StatPearls - NCBI Bookshelf".
  2. Foard DE, Haber AH (1970). "Physiologically normal senescence in seedlings grown without cell division after massive gamma-irradiation of seeds". Radiat. Res. 42 (2): 372–80. PMID 5442405.
  3. Knab LM, Boller AM, Mahvi DM (2014). "Cholecystitis". Surg. Clin. North Am. 94 (2): 455–70. doi:10.1016/j.suc.2014.01.005. PMID 24679431.
  4. Gomes CA, Junior CS, Di Saverio S, Sartelli M, Kelly MD, Gomes CC, Gomes FC, Corrêa LD, Alves CB, Guimarães SF (2017). "Acute calculous cholecystitis: Review of current best practices". World J Gastrointest Surg. 9 (5): 118–126. doi:10.4240/wjgs.v9.i5.118. PMC 5442405. PMID 28603584.
  5. "Imaging of Cholecystitis : American Journal of Roentgenology : Vol. 196, No. 4 (AJR)".
  6. Huffman, JL.; Schenker, S. (2010). "Acute acalculous cholecystitis: a review". Clin Gastroenterol Hepatol. 8 (1): 15–22. doi:10.1016/j.cgh.2009.08.034. PMID 19747982. Unknown parameter |month= ignored (help)
  7. "Acute cholecystitis | Radiology Reference Article |".