title: The clinical importance of a thick-walled, tender gall-bladder without stones on ultrasonography.
abstract: Ultrasound examinations of 563 patients with right upper quadrant pain and a clinical suspicion of acute cholecystitis were reviewed. In 31 patients, a tender, dilated gall-bladder with a thick (more than 4 mm) partly hypoechoic wall without any detectable calculi was found on the emergency examination. This was interpreted as due to acute acalculous cholecystitis. None of the patients was critically ill. Twenty-one of the patients had follow-up studies with either oral cholecystography, cholangiography, or ultrasound. Fourteen of the 21 had gall-bladder calculi while seven did not. These seven patients presumably represent the true frequency (1.2%) of acute acalculous cholecystitis in this clinical setting. In five other patients with an initial diagnosis of acute acalculous cholecystitis the gall-bladder wall thickening probably was secondary to concomitant pancreatitis, appendicitis, hepatitis or peptic ulcer disease. A meticulous and careful search for gall-bladder calculi should be performed in the presence of a dilated, tender thick-walled gall-bladder.
authors.affiliation: Department of Diagnostic Radiology, University of Lund, Malmo General Hospital, Sweden.
authors.forename: O
authors.initials: O
authors.lastname: Ekberg
authors.forename: S
authors.initials: S
authors.lastname: Weiber
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002764:Cholecystitis / Q000000981:diagnostic imaging* / Q000473:pathology; D005260:Female; D005704:Gallbladder / Q000000981:diagnostic imaging* / Q000473:pathology; D006801:Humans; D008297:Male; D008875:Middle Aged; D014463:Ultrasonography