Abstract
Acute cholecystitis is a common surgical emergency and ultrasound (US) is currently considered the first-line diagnostic imaging test. The relative accuracy of computed tomography (CT) in detecting acute cholecystitis has received little attention in the literature. We report a case series of 113 patients who underwent emergency laparoscopic cholecystectomy at a tertiary surgical centre in Australia, between 2014 and 2016, after undergoing both US and CT examination for acute right upper quadrant pain. Both US and CT had a relatively low sensitivity in detecting acute cholecystitis in the patients with histologically proven acute cholecystitis (47% and 45% respectively) but high specificity (84% and 79% respectively). As expected, US was much more sensitive in detecting cholelithiasis (92%) in comparison to CT (55%). With the added advantage of CT in excluding other alternative intra-abdominal pathology in patients presenting with acute right upper quadrant pain, and similar accuracy in detecting acute cholecystitis, the need for ultrasound may be negated in cases where acute cholecystitis has been confirmed on CT. However, it is noted that both US and CT had a significant false negative rate for acute cholecystitis, and if there remains a clinical suspicion despite initial normal imaging, repeat delayed imaging and/or surgical opinion may be warranted.
Highlights
With the added advantage of computed tomography (CT) in excluding other alternative intra-abdominal pathology in patients presenting with acute right upper quadrant pain, and similar accuracy in detecting acute cholecystitis, the need for ultrasound may be negated in cases where acute cholecystitis has been confirmed on CT
It is noted that both US and CT had a significant false negative rate for acute cholecystitis, and if there remains a clinical suspicion despite initial normal imaging, repeat delayed imaging and/or surgical opinion may be warranted
The primary aim of this study is to investigate the relative accuracy of CT and US in the diagnosis of acute cholecystitis, which is of interest to emergency physicians, surgeons and radiologists
Summary
Ultrasound (US) is the preferred initial imaging modality for biliary tract disease including suspected cholecystitis [4]. It has a greater sensitivity and specificity than CT or MRI. US is highly sensitive in diagnosing cholelithiasis and is radiation free. It is limited by the patient’s body habitus, potential obscuring bowel gas, the requirement for patients to fast for at least 6 to 8 hours prior to scanning and the availability of equipment and trained sonographers after-hours [7]
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