Sonomorphology of the gallbladder in critically ill patients. Value of a scoring system and follow-up examinations.

Abstract

The aim of the study was to assess the value of a scoring system for the diagnosis of acalculous cholecystitis (AC) on ultrasound (US) follow-up examinations and to discuss the merits of scoring system compared to clinical outcome and pathohistologic findings. In this prospective study, 21 patients at the intensive care unit (ICU) of a medical department were examined by follow-up US. Sonographic parameters of the gallbladder (GB) were obtained (longitudinal and transversal diameter, wall thickening, contents, and pericholecystic fluid) and scored (2 points: distension of GB, thickening of GB wall; 1 point: striated thickening of GB wall, sludge, and pericholecystic fluid; range (0-8). The US findings were correlated with clinical findings and histology at cholecystectomy or autopsy. Of a total of 77 follow-up examinations in these 21 patients, US demonstrated GB distension in 19 patients, wall thickening in 18, sludge in 15, striated thickening of the GB wall in 13, and pericholecystic fluid in 12 patients. Of these, 41 (53%) examinations were scored > or = 6, and 36 (47%) examinations < or = 5. None of the patients with a maximum score during follow-up of < or = 5 (n = 8) had pathohistologic proof of AC or died due to GB complications. Patients with maximum scores of > or = 6: had pathohistologic proof of AC (n = 4); survived with normalization of GB morphology (n = 4); had a normal GB at autopsy (n = 1); or were lost for pathohistologic proof at autopsy (n = 2). Our results indicate that regular, short-term follow-up allows early diagnosis and immediate therapy for AC. The scoring system could be helpful in differentiating between patients with an abnormal GB without AC (score < or = 5) and those with an abnormal GB (score > or = 6) with a suspicion of AC. In the latter group, more aggressive diagnostic and therapeutic procedures may be indicated.