Acute Cholecystitis

A 72 year old female presented with right abdominal pain, fever, and elevated WCC. The axial contrast-enhanced CT shows a distended gallbladder with wall thickening and stranding of the surrounding fat. No gallstones could be identified.
Typical CT findings in acute cholecystitis are wall thickening, pericholecystic stranding, and distension. When these findings are present, acute cholecystitis may be suggested. Other findings may include pericholecystic fluid, gallstones, luminal membranes and gas in the gallbladder wall. The sensitivity of CT may be as low as 52%1, however a more recent study has demonstrated a sensitivity of 92% and specificity of 99%2. Findings of mural or luminal gas, intraluminal membranes, irregular wall or pericholecystic abscess are strongly suggestive of gangrenous cholecystitis.
References:
1. Fidler J, Paulson EK, Layfield L. CT evaluation of acute cholecystitis: findings and usefulness in diagnosis. AJR 1996; 166:1085-1088
2. Bennett GL, et al. CT Findings in Acute Gangrenous Cholecystitis. AJR 2002; 178:275-281
Credit: Dr Laughlin Dawes
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