Preliminary Diagnosis: Cholecystitis

I. What imaging technique is first-line for this diagnosis?

  • Ultrasound

II. Describe the advantages and disadvantages of this technique for diagnosis of cholecystitis.

Advantages

  • Relatively inexpensive

  • Quick

  • Does not use ionizing radiation

Disadvantages

  • Difficult to assess gallbladder if patient just ate or gallbladder is contracted

  • Difficult to assess if patient has a large body habitus

  • Results dependent on ability of patient to cooperate during the exam and sonographer’s skill

III. What are the contraindications for the first-line imaging technique?

No contraindications

IV. What alternative imaging techniques are available?

  • Hepatobiliary scintigraphy

  • CT of the abdomen and pelvis with or without contrast

  • MRI

  • ERCP

V. Describe the advantages and disadvantages of the alternative techniques for diagnosis of cholecystitis.

Hepatobiliary scintigraphy
Advantage

  • Excellent sensitivity and specificity for the diagnosis of cholecystitis

Disadvantages

  • More expensive than ultrasound

  • Requires more patient cooperation than ultrasound

CT of the abdomen and pelvis with or without contrast
Advantages

  • Findings consistent with cholecystitis, such as fat stranding, are easily seen

Disadvantages

  • Exposure to ionizing radiation

  • More expensive than ultrasound

MRI
Advantages

  • Findings consistent with cholecystitis, including stones, are easily seen.

Disadvantages

  • Significantly more expensive than ultrasound

  • Time consuming

  • Requires significant patient cooperation to minimize artifact

ERCP
Advantages

  • Can see filling of gallbladder and may document common bile duct (CBD) stones in patients with associated cholangitis

Disadvantage

  • Invasive test and has significant risk of associated complications

  • More expensive than ultrasound

VI. What are the contraindications for the alternative imaging techniques?

Hepatobiliary scintigraphy

Relative contraindication in pregnancy

CT of the abdomen and pelvis with or without contrast

Relative contraindication in pregnancy

MRI

Absolute contraindication in those with non-MR-compatible hardware

ERCP

Relative contraindication in pregnancy

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