Acute cholecystitis is a common surgical emergency and ultrasound (US) is currently considered the first-line diagnostic imaging test. The relative accuracy of computed tomography (CT) in detecting acute cholecystitis has received little attention in the literature. We report a case series of 113 patients who underwent emergency laparoscopic cholecystectomy at a tertiary surgical centre in Australia, between 2014 and 2016, after undergoing both US and CT examination for acute right upper quadrant pain. Both US and CT had a relatively low sensitivity in detecting acute cholecystitis in the patients with histologically proven acute cholecystitis (47% and 45% respectively) but high specificity (84% and 79% respectively). As expected, US was much more sensitive in detecting cholelithiasis (92%) in comparison to CT (55%). With the added advantage of CT in excluding other alternative intra-abdominal pathology in patients presenting with acute right upper quadrant pain, and similar accuracy in detecting acute cholecystitis, the need for ultrasound may be negated in cases where acute cholecystitis has been confirmed on CT. However, it is noted that both US and CT had a significant false negative rate for acute cholecystitis, and if there remains a clinical suspicion despite initial normal imaging, repeat delayed imaging and/or surgical opinion may be warranted.
References
[1]
Kimura, Y., Takada, T., Kawarada, Y., Nimura, Y., Hirata, K., Sekimoto, M., et al. (2007) Definitions, Pathophysiology, and Epidemiology of Acute Cholangitis and Cholecystitis: Tokyo Guidelines. Journal of Hepato-Biliary-Pancreatic Surgery, 14, 15-26. https://doi.org/10.1007/s00534-006-1152-y
[2]
Bayram, C., Valenti, L. and Miller, G.C. (2013) Gallbladder Disease. Australian Family Physician, 42, 443.
[3]
Zhou, M.W., Gu, X.D., Xiang, J.B. and Chen, Z.Y. (2014) Comparison of Clinical Safety and Outcomes of Early versus Delayed Laparoscopic Cholecystectomy for Acute Cholecystitis: A Meta-Analysis. The Scientific World Journal, 2014, Article ID: 274516. https://doi.org/10.1155/2014/274516
[4]
Ansaloni, L., Pisano, M., Coccolini, F., Peitzmann, A.B., Fingerhut, A., Catena, F., et al. (2016) WSES Guidelines on Acute Calculous Cholecystitis. World Journal of Emergency Surgery, 11, 25. https://doi.org/10.1186/s13017-016-0082-5
[5]
Shea, J.A., Berlin, J.A., Escarce, J.J., Clarke, J.R., Kinosian, B.P., Cabana, M.D., Tsai, W.W., et al. (1994) Revised Estimates of Diagnostic Test Sensitivity and Specificity in Suspected Biliary Tract Disease. Archives of Internal Medicine, 154, 2573-2581. https://doi.org/10.1001/archinte.1994.00420220069008
[6]
Barie, P.S. and Eachempati, S.R. (2003) Acute Acalculous Cholecystitis. Current Gastroenterology Reports, 5, 302-309. https://doi.org/10.1007/s11894-003-0067-x
[7]
Greiner, L. (2009) Clinical Abdominal Ultrasonography (US)—Benefits, Potentials, and Limitations. Medical Ultrasonography, 11, 33-36.
[8]
Kiewiet, J.J.S., Leeuwenburgh, M.M.N., Bipat, S., Bossuyt, P.M.M., Stoker, J., Boermeester, M.A., et al. (2012) A Systemic Review and Meta-Analysis of Diagnostic Performance of Imaging in Acute Cholecystitis. Radiology, 264, 708-720. https://doi.org/10.1148/radiol.12111561
[9]
Patel, N.B., Oto, A. and Thomas, S. (2013) Multidetector CT of Emergent Biliary Pathologic Conditions. Radiographics, 33, No. 7. https://doi.org/10.1148/rg.337125038
[10]
Mirvis, S.E., Whitley, N.O. and Miller, J.W. (1987) CT Diagnosis of Acalculous Cholecystitis. Journal of Computer Assisted Tomography, 11, 83-87. https://doi.org/10.1097/00004728-198701000-00016
[11]
Van Randen, A., Lameris, W., van Es, H.W., van Heesewijk, H.P., van Ramshorst, B., Ten Hove, W., Bouma, W.H., et al. (2011) A Comparison of the Accuracy of Ultrasound and Computed Tomography in Common Diagnoses Causing Acute Abdominal Pain. European Radiology, 21, 1535-1545. https://doi.org/10.1007/s00330-011-2087-5
[12]
Hwang, H., Marsh, I. and Doyle, J. (2014) Does Ultrasonography Accurately Diagnose Acute Cholecystitis? Improving Diagnostic Accuracy Based on a Review at a Regional Hospital. Canadian Journal of Surgery, 57, 162-168. https://doi.org/10.1503/cjs.027312
[13]
Fagenholz, P.J., Fuentes, E., Kaafarani, H., Cropano, C., King, D., de Moya, M., et al. (2015) Computed Tomography Is More Sensitive than Ultrasound for the Diagnosis of Acute Cholecystitis. Surgical Infections, 16, 509-512. https://doi.org/10.1089/sur.2015.102
[14]
Barie, P.S. (2001) Acute Acalculous Cholecystitis in Surgical Treatment: Evidence-Based and Problem-Oriented. Zuckschwerdt, Munich.
[15]
Iyer, S.G., Ravishankar, K.D., Huang, E. and Masud, K. (2007) Acute Acalculous Cholecystitis: Challenging the Myths. HPB (Oxford), 9, 131-134. https://doi.org/10.1080/13651820701315307
[16]
Pinto, A., Reginelli, A., Cagini, L., Coppolino, F., Ianora, A.A.S., Bracale, R., Giganti, M. and Romano, L. (2013) Accuracy of Ultrasonography in the Diagnosis of Acute Calculous Cholecystitis: Review of the Literature. Critical Ultrasound, 5, S11. https://doi.org/10.1186/2036-7902-5-S1-S11
[17]
Van Breda Vriesman, A.C., Engelbrecht, M.R., Smithuis, R.H.M. and Puylaert, J.B.C.M. (2007) Diffuse Gallbladder Wall Thickening: Differential Diagnosis. American Journal of Roentgenology, 188, 495-501. https://doi.org/10.2214/AJR.05.1712
