Journal of Ultrasound in Medicine, Vol 10, Issue 11 603-606, Copyright © 1991 by American Institute of Ultrasound in Medicine
Gangrenous cholecystitis: new observations on sonography
S. A. Teefey, R. L. Baron, H. M. Radke and S. A. Bigler
Department of Radiology, University of Washington School of Medicine, Seattle.
We studied 25 patients with gangrenous cholecystitis and observed a new
sonographic finding--striated thickening of the gallbladder wall--and three
patterns of pericholecystic fluid collections. Heterogeneous thickening of
the gallbladder wall was characterized by either multiple striations
(alternating hypoechoic and hyperechoic layers) or irregular mass-like
protrusions projecting into the gallbladder lumen. We observed striated
thickening far more frequently (in 10 of 25 patients) than other findings
reported previously as being associated with gangrenous cholecystitis, such
as intraluminal membranes (1 in 25 patients) and masslike protrusions into
the gallbladder lumen (1 in 25 patients). Although the sensitivity and
specificity of this finding cannot be determined by our study, we believe
that mural striations in cases of acute cholecystitis should raise the
question of gangrenous changes. Additionally, we found that two subtypes of
pericholecystic fluid collections (types II and III) were associated with
gallbladder wall perforation and abscess formation more frequently than
type I collections.
