415.Acute Cholecystitis（III）

Ultrasound is the preferred modality of choice in the initial workup of right upper quadrant pain. The most sensitive ultrasound findings of acute cholecystitis are gallstones and presence of a sonographic Murphy’s sign. A positive sonographic Murphy’s sign is when the patient feels maximal abdominal tenderness from the pressure of the ultrasound probe over the gallbladder area while in deep inspiration. However, the sonographic Murphy’s sign cannot be assessed if the patient has been given analgesics prior to the ultrasound exam.

Other secondary signs include distended gallbladder, thickened gallbladder wall >3mm, hyperemic gallbladder wall, and pericholecystic fluid. These are less specific and can be present in other entities such as hepatitis, congestive heart failure, pancreatitis, cirrhosis, and hypoalbuminemia.

Computed tomography (CT) findings of acute cholecystitis include gallstones, gallbladder distention, gallbladder wall thickening, mucosal hyperenhancement, pericholecystic fluid/fat stranding, and sludge. However, CT is less sensitive than ultrasound.

Treatment for acute cholecystitis is typically cholecystectomy. However, in patients who are unstable, percutaneous transhepatic cholecystostomy drainage may be appropriate with antibiotics. Gallbladder ischemia, infection, and perforation can occur if acute cholecystitis is left untreated.

Notes：

1. tenderness 压痛    rebound tenderness 反跳痛

2. analgesics /ˌæn(ə)l'dʒiːzɪk/ /'ænl'dʒizɪk/ n. 止痛剂，镇痛剂 adj. 止痛的

3. congestive /kən'dʒɛstɪv/ /kən'dʒɛstɪv/ adj. 充血的

4. hypoalbuminemia /ˌhaipəuæl,bju:mə'ni:miə//ˌhaipəuæl,bju:mə'ni:miə/n低白蛋白血症

5. sludge /'slʌdʒ/ /slʌdʒ/ n. 沉淀物，烂

6. cholecystectomy /ˌkɒlɪsɪs'tektəmɪ/ /ˌkɑləsɪs'tɛktəmi/ n. 胆囊切除术

来源：每天朗读一段医学影像学英语文章

圈主

深圳市人民医院放射科副主任医师杨敏洁

---