The sonographic diagnosis of acute gangrenous cholecystitis: importance of the Murphy sign.
The sonographic Murphy sign is defined as the presence of maximal tenderness elicited by direct pressure of the transducer over a sonographically localized gallbladder. The reported prevalence of this sign is more than 95% in patients with acute cholecystitis. In this series of 18 patients with pathologically proved gangrenous cholecystitis, the sonographic Murphy sign was positive in only six (33%). Clinical examination showed a positive Murphy sign in eight patients (44%), diffuse abdominal pain in nine patients (50%), and no pain in one patient (6%). Other sonographic findings included pericholecystic fluid (10), thickening of the gallbladder wall (10), and a dilated gallbladder (five). Our experience suggests that the absence of the Murphy sign increases the possibility of gangrenous cholecystitis in patients with abdominal pain and sonographic findings of cholecystitis.
Simeone
J F
JF
Department of Radiology, Massachusetts General Hospital, Boston 02114.
Brink
J A
JA
Mueller
P R
PR
Compton
C
C
Hahn
P F
PF
Saini
S
S
Silverman
S G
SG
Tung
G
G
Ferrucci
J T
JT
D000005:Abdomen; D002764:Cholecystitis / Q000175:diagnosis*; D005704:Gallbladder / Q000473:pathology; D005734:Gangrene; D006801:Humans; D010146:Pain; D011312:Pressure; D014463:Ultrasonography / Q000379:methods*