Acute Cholecystitis: Do Sonographic Findings and WBC Count Predict Gangrenous Changes?
ABSTRACT The purpose of our study was to determine, first, if gallbladder wall striations in patients with sonographic findings suspicious for acute cholecystitis are associated with gangrenous changes and certain histologic features; and, second, if WBC count or other sonographic findings are associated with gangrenous cholecystitis.
Sixty-eight patients who underwent cholecystectomies within 48 hours of sonography comprised the study group. Sonograms and reports were reviewed for wall thickness, striations, Murphy sign, pericholecystic fluid, wall irregularity, intraluminal membranes, and luminal short-axis diameter. Medical records were reviewed for WBC count and pathology reports for the diagnosis. Histologic specimens were reviewed for pathologic changes. Statistical analyses tested for associations between nongangrenous and gangrenous cholecystitis and sonographic findings and for associations between wall striations and histologic features.
Ten patients had gangrenous cholecystitis and 57, nongangrenous cholecystitis. One had cholesterolosis. Thirty patients had wall striations: 60% had gangrenous and 42% nongangrenous cholecystitis. There was no association with the pathology diagnosis (p = 0.32). There was no association between any histologic feature and wall striations (p ≥ 0.19). A Murphy sign was reported in 70% of patients with gangrenous cholecystitis and in 82% with nongangrenous cholecystitis; there was no association with the pathology diagnosis (p = 0.39). Wall thickness and WBC count were greater in patients with gangrenous cholecystitis than in those with nongangrenous cholecystitis (p ≤ 0.04).
Gallbladder wall thickening and increased WBC counts were associated with gangrenous cholecystitis; however, there was considerable overlap between the two groups. Wall striations and a negative Murphy sign were not associated with gangrenous cholecystitis.
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ABSTRACT: BACKGROUND: Ultrasonography has a high sensitivity and positive predictive value (PPV) for diagnosing cholecystitis in adults. The objective of this study was to determine the sensitivity and PPV of ultrasonography in the diagnosis of pediatric cholecystitis. METHODS: We performed a single-institution retrospective review of the records of all patients undergoing cholecystectomy with a preoperative ultrasound during 2005-2010. We calculated sensitivity, specificity, and PPV using pathologic findings as the standard for the diagnosis of cholecystitis. RESULTS: In the 223 included patients, the median (interquartile range) age was 14 y (11-16 y); and 64% were female. Preoperative symptoms of abdominal pain were reported in 98% of patients. A diagnosis of cholecystitis was reported in 10% (23 of 223) of ultrasound readings. Pathologic diagnosis of cholecystitis was present in 80% (179 of 223) of cholecystectomy specimens, with 8% (15 of 179) having acute cholecystitis, 83% (148 of 179) chronic cholecystitis, and 9% (16 of 179) both. Sensitivity of ultrasound findings ranged from 6% for Murphy's sign to 66% for cholelithiasis. Positive predictive values ranged from 67% for Murphy's sign to 87% for gallbladder sludge. Presence of any one ultrasound sign had a sensitivity of 82% and PPV of 80%. CONCLUSIONS: Ultrasound findings in pediatric cholecystitis have lower sensitivities and PPVs than reported in adults. These differences may be explained by the higher prevalence of chronic cholecystitis in children, which suggests that children may have milder episodes of self-limited gallbladder inflammation compared with adults, which may lead to a delay in treatment.Journal of Surgical Research 04/2013; DOI:10.1016/j.jss.2013.03.066 · 2.12 Impact Factor
Article: Gallbladder Wall ThickeningAmerican Journal of Roentgenology 01/2014; 202(1):W1-W12. DOI:10.2214/AJR.12.10386 · 2.74 Impact Factor
- Journal of Surgical Research 01/2014; 186(1):87–88. DOI:10.1016/j.jss.2013.06.050 · 2.12 Impact Factor