Sonographic Diagnosis of Complicated Cholecystitis.

OBJECTIVES: Early detection of the complications of cholecystitis is important for clinical management, yet only a small percentage of patients have a correct diagnosis before surgery. The purpose of our study was to identify sonographic findings that are associated with complicated cholecystitis. METHODS: Sonographic, surgical, and pathologic reports were reviewed for 70 patients who underwent early cholecystectomies from January 2010 to August 2014. Sonograms were assessed for 16 independent variables. Statistical analyses were performed to evaluate associations between various sonographic features and complicated cholecystitis. RESULTS: Sonographic signs associated with complicated cholecystitis (P< .05) were a greater short-axis gallbladder diameter (mean, 4.4 versus 4.0 cm), a greater mean wall thickness (5.6 versus 4.2 mm), and the likelihood of wall striations, gallbladder echogenic content, pericholecystic free fluid, and local inflammatory fat changes. Specific sonographic signs, such as sloughed intraluminal membranes, were detected in a small percentage of cases (10%). None of the sonographic features evaluated in this study was found to be sensitive and specific enough to indicate complicated cholecystitis. In most cases, sonograms reflected severe inflammation, with multiple sonographic signs. CONCLUSIONS: Although multiple sonographic signs are associated with complicated cholecystitis, none of them is sensitive and specific enough to definitively diagnose it. Sonograms usually reflect severe inflammation, with numerous sonographic signs. Thus, in the right clinical context, sonograms of severe cholecystitis should alert radiologists to the possibility of complications.

Diagnosis of gallbladder perforation by ultrasound.

PURPOSE: The aim of this study was to identify possible pitfalls in the sonographic evaluation of perforated gallbladders. METHODS: This is a retrospective analysis of sonograms of 11 patients diagnosed by surgery or pathology with perforated gallbladder. Sonograms were evaluated for multiple sonographic features. RESULTS: Only three patients (27%) were diagnosed correctly with gallbladder perforation by ultrasonography prior to surgery. Gangrenous cholecystitis was reported in 10 cases (90%). Visualization of a wall defect was demonstrated in only five cases (45%) and was associated with a focal echogenic soft-tissue mass. CONCLUSION: Missed perforations by ultrasound may partially result from technical inadequacies.

Giant omental hemorrhagic cyst presenting as acute hemorrhagic anemia in a 21-month-old infant.

An omental cyst is a very rare pathology, especially in small infants. Children generally present with abdominal distention with or without a palpable mass. The mass may be huge, simulating ascites. The most common presentation in children is that of a small-bowel obstruction. The differential diagnosis includes intestinal duplication cyst, ovarian, choledochal, pancreatic, splenic, or renal cysts, hydronephrosis, cystic teratoma, hydatid cyst, and ascites. We describe the clinical presentation, imaging features, surgical treatment, and postoperative course of a 21-month-old female infant with a congenital giant omental cyst. This entity is extremely rare but should be included in the differential diagnosis in similar cases.

Superior mesenteric artery-related aortic pseudomass as a form of reverberation artifact in a 10-year-old boy.

Artifacts are encountered routinely in clinical ultrasonography practice. The ability to recognize and eliminate potentially correctable ultrasound artifacts is of great importance to image quality improvement and optimal patient care. We describe an example of a superior mesenteric artery-related pseudomass as a form of reverberation artifact that could lead to misinterpretation of sonographic findings. We present the ultrasonographic and computed tomography angiography findings and give an explanation for the appearance of the artifact.