| Theme |
The Present State of Management of Acute Cholangitis and Cholecystitis |
| Title |
Sonographic Diagnosis of Acute Cholecystitis and Cholangitis |
| Author |
Jiro Hata |
Department of Endoscopy and Ultrasound, Kawasaki Medical School |
| Author |
Ryosuke Kawai |
Department of Endoscopy and Ultrasound, Kawasaki Medical School |
| Author |
Hiroshi Imamura |
Department of Endoscopy and Ultrasound, Kawasaki Medical School |
| Author |
Noriaki Manabe |
Department of Endoscopy and Ultrasound, Kawasaki Medical School |
| Author |
Ai Iida |
Department of Endoscopy and Ultrasound, Kawasaki Medical School |
| [ Summary ] |
In the diagnostic strategy of acute cholecystitis, ultrasound examination should be considered as the first choice of imaging modality for its non‒invasiveness. Gall bladder swelling, wall thickening, calculi, debris, and sonographic Murphy's sign are reliable and reproducible findings regardless of the equipment used for examination. Ultrasound is also useful for assessment of cholecystitis severity. Pericholecystic fluid, intraluminal flap, and intraluminal/intramural gas are the major findings of more severe cholecystitis. Although it is difficult to diagnose gangrenous cholecystitis by conventional ultrasound, contrast ultrasound with SonazoidTM has been shown to be useful for this purpose. Sonographic diagnosis of acute cholangitis can be challenging. Although bile duct dilatation, stone impaction and tumors suggest bile duct obstruction, they do not necessarily indicate coexisting inflammation. Thickening of the bile duct wall and intraluminal debris are more suggestive；however, these findings vary according to patient condition, examiner skill, and sonographic equipment performance. |