Acute cholecystitis diagnostic study of choice
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Cholescintigraphy is the gold standard for the diagnosis of acute cholecystitis. Transabdominal ultrasonography is the initial study of choice for the diagnosis of acute cholecystitis and gallstones. Thickened gallbladder, gallstones or sludge, and pericholecystic fluid are the findings associated with transabdominal ultrasound in patients with acute cholecystitis.
Diagnostic Study of Choice
Gold standard/Study of choice:
- Cholescintigraphy is the gold standard for the diagnosis of acute cholecystitis. Transabdominal ultrasonography is the initial study of choice for the diagnosis of acute cholecystitis and gallstones.
- The following result of transabdominal ultrasonography is confirmatory of acute cholecystitis:
- The ultrasound should be performed when:
The comparison table for diagnostic studies of choice for acute cholecystitis
The table below summarizes the sensitivities and specificities of the diagnostic studies for acute cholecystitis.
✔= The best test based on the sensitivity and specificity ✔✔=Gold standard
Sequence of Diagnostic Studies
There is no specific sequence of the diagnostic studies for acute cholecystitis. Ultrasound is the initial test performed in the suspected case of acute cholecystitis. Alternative tests are performed in diagnostic uncertainity.
- The transabdominal ultrasonography is the initial study of choice and should be performed when:
- Cholescintigraphy is the gold standard for the diagnosis of acute cholecystitis. Cholescintigraphy is an alternative method of imaging and uses technetium-labeled hepatic 2,6-dimethyl-iminodiacetic acid (HIDA) in difficult cases or uncertain diagnosis.
- Abdominal MRI and CT scan can also be used for the diagnosis of acute cholecystitis and it's complications. These modalities are not preferred because:
- More time is needed for the tests
- Limited availability
The diagnostic criteria for acute cholecystitis is:
A. Local signs of inflammation etc.
B. Systemic signs of inflammation etc.
C. Imaging findings
Suspected diagnosis: One item in A + one item in B
Definite diagnosis: One item in A + one item in B + C
|Adopted from Journal of Hepato-Biliary-Pancreatic Sciences|
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