Intravenous cholegraphy and diaphragmatic movements in the differential diagnosis of acute cholecystitis (author's transl)

Abstract

Intravenous cholegraphy was performed in 79 patients with abdominal symptoms suggestive of acute cholecystitis. Three excretion patterns were found: 1. Opacification of the gall bladder and common bile duct. 2. Opacification of the common bile duct. 3. No opacification of the gall bladder or common bile duct. 29% showed opacification of the gall bladder and common bile duct; none of these had acute cholecystitis. 51% of cases showed opacification of the common bile duct only; 82.5% of these had acute cholecystitis. 79.4% of patients with this excretion pattern were shown to have acute cholecystitis at operation. In the other cases, absence of opacification of the gall bladder was due to obstruction of the cystic duct, caused either by concretions or fibrosis. The biliary tree was not visible in 21% of cases. The most common diagnosis was acute cholecystitis, but this excretion pattern is of limited value in differential diagnosis. The value of this examination is stressed, but it must be carried on for an adequate period. Mobility of the right diaphragm was examined preoperatively in 34 patients. Compared with patients with other diagnoses, there was a significant number of patients with acute cholecystitis who showed limited movement. The examination may be regarded as supplementary to intravenous cholegraphy in the diagnosis of acute cholecystitis.