title: The sonographic diagnosis of acute gangrenous cholecystitis: importance of the Murphy sign.
abstract: 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.
authors.affiliation: Department of Radiology, Massachusetts General Hospital, Boston 02114.
authors.forename: J F
authors.initials: JF
authors.lastname: Simeone
authors.forename: J A
authors.initials: JA
authors.lastname: Brink
authors.forename: P R
authors.initials: PR
authors.lastname: Mueller
authors.forename: C
authors.initials: C
authors.lastname: Compton
authors.forename: P F
authors.initials: PF
authors.lastname: Hahn
authors.forename: S
authors.initials: S
authors.lastname: Saini
authors.forename: S G
authors.initials: SG
authors.lastname: Silverman
authors.forename: G
authors.initials: G
authors.lastname: Tung
authors.forename: J T
authors.initials: JT
authors.lastname: Ferrucci
mesh_terms: D000005:Abdomen; D002764:Cholecystitis / Q000175:diagnosis*; D005704:Gallbladder / Q000473:pathology; D005734:Gangrene; D006801:Humans; D010146:Pain; D011312:Pressure; D014463:Ultrasonography / Q000379:methods*