Update on bedside ultrasound (US) diagnosis of acute cholecystitis (AC)

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• 作者：Maria Francesca Zenobii ; Esterita Accogli…
• 关键词：Bedside ultrasound (US) ; Acute cholecystitis (AC) ; Diagnosis
• 刊名：Internal and Emergency Medicine
• 出版年：2016
• 出版时间：March 2016
• 年：2016
• 卷：11
• 期：2
• 页码：261-264
• 全文大小：725 KB
• 参考文献：1.Hirota M, Takada T, Kawarada Y et al (2007) Diagnostic criteria and severity assessment of acute cholecystitis: Tokyo guidelines. J Hepatobiliary Pancreat Surg 14(1):78–82CrossRef PubMed PubMedCentral
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  3.Arienti V, Di Giulio R, Cogliati C et al (2014) Bedside ultrasonography (US), echoscopy and US point of care as a new kind of stethoscope for internal medicine departments: the training program of the Italian Internal Medicine Society (SIMI). Intern Emerg Med 9(7):805–814CrossRef PubMed
  4.Summers SM, Scruggs W, Menchine MD et al (2010) A prospective evaluation of emergency department bedside ultrasonography for the detection of acute cholecystitis. Ann Emerg Med 56(2):114–122CrossRef PubMed
  5.Hamish H, Marsh I, Doyle J (2014) Does ultrasonography accurately diagnose acute cholecystitis? Improving diagnostic accuracy based on a review at a regional hospital. Can J Surg 57(3):162–168CrossRef
  
• 作者单位：Maria Francesca Zenobii (1)
  Esterita Accogli (1)
  Andrea Domanico (1)
  Vincenzo Arienti (1)
  
  1. Centre of Research and Learning in Ultrasound, Department of Internal Medicine, Maggiore Hospital, Bologna, Italy
  
• 刊物主题：Internal Medicine;
• 出版者：Springer Milan
• ISSN：1970-9366

文摘

Acute cholecystitis (AC) represents a principal cause of morbidity worldwide and is one of the most frequent reasons for hospitalization due to gastroenteric tract diseases. AC should be suspected in presence of clinical signs and of gallstones on an imaging study. Upper abdominal US represents the first diagnostic imaging step in the case of suspected AC. Computed tomography (CT) with intravenous contrast (IV) or magnetic resonance imaging (MRI) with gadolinium contrast and technetium hepatobiliary iminodiacetic acid (Tc-HIDA) can be employed to exclude complications. US examination should be performed with right subcostal oblique, with longitudinal and intercostal scans. Normal gallbladder US findings and AC major and minor US signs are described. Polyps, sludge and gallbladder wall thickening represent the more frequent pitfalls and they must be differentiated from stones, duodenal artifacts and many other non-inflammatory conditions that cause wall thickening, respectively. By means of bedside ultrasound, the finding of gallstones in combination with acute pain, when the clinician presses the gallbladder with the US probe (the sonographic Murphy’s sign), has a 92.2 % positive predictive value for AC. In our preliminary experience, bedside US-performed by echoscopy (ES) and/or point-of-care US (POCUS) demonstrated good reliability in detecting signs of AC, and was always integrated with physical examination and performed by a skilled operator.