title: Prompt visualization of the gallbladder with a rim sign--acute or subacute cholecystitis?
abstract: An immunosuppressed, neutropenic patient developed symptoms and signs of acute cholecystitis. Gallbladder ultrasound was consistent with acute cholecystitis. Technetium-99m-diisopropyl iminodiacetic acid (DISIDA) scan showed a rim sign, but with normal gallbladder visualization. On restudy 72 hr later when the patient's WBC count was recovering, the 99mTc-DISIDA scan again showed a persistent rim sign, but now there was no gallbladder visualization at 1 hr, a pattern strongly predictive for acute complicated cholecystitis. Biliary drainage was performed by percutaneous cholecystotomy with clinical improvement. Semielective cholecystectomy performed 8 wk later confirmed both acute and chronic cholecystitis. We describe the rim sign and its variants, mechanisms of causation, prognostic importance and correlate our report with a review of the literature.
authors.affiliation: Department of Radiology, Wilford Hall USAF Medical Center, Lackland AFB, Texas 78236-5300.
authors.forename: J C
authors.initials: JC
authors.lastname: Morrison
authors.forename: A
authors.initials: A
authors.lastname: Ramos-Gabatin
authors.forename: R G
authors.initials: RG
authors.lastname: Gelormini
authors.forename: J W
authors.initials: JW
authors.lastname: Brown
authors.forename: N L
authors.initials: NL
authors.lastname: Pitts
mesh_terms: D000208:Acute Disease; D000328:Adult; D002764:Cholecystitis / Q000000981:diagnostic imaging* / Q000453:epidemiology; D005704:Gallbladder / Q000000981:diagnostic imaging*; D006801:Humans; D007098:Imino Acids; D016867:Immunocompromised Host; D008297:Male; D015609:Organotechnetium Compounds; D011237:Predictive Value of Tests; D011877:Radionuclide Imaging; D019785:Technetium Tc 99m Disofenin; D013997:Time Factors
chemical_list: D007098:Imino Acids; D015609:Organotechnetium Compounds; D019785:Technetium Tc 99m Disofenin