Abdominal contrast tomography in the evaluation of the gall-bladder and biliary tract (with emphasis upon jaundiced patients)

Contrast tomography of the gallbladder wall and ultrasonography in the diagnosis of acute cholecystitis

Rapid and reliable diagnostic methods are necessary for regular early surgical intervention in patients with acute cholecystitis. Eighty-three patients with clinical suspicion of acute cholecystitis were investigated with ultrasonography (US) and contrast tomography of the gallbladder wall (CTGW). The diagnosis in each case included in the study was verified either at operation or follow-up cholecystography. The sensitivity and specificity of US were 69 and 100 per cent, respectively. With CTGW the corresponding figures were 73 and 100 per cent. The combined use of these methods resulted in a sensitivity of 89 per cent and a specificity of 100 per cent.

ULtrasonography in acute cholecystitis

Forty cases of acute cholecystitis, surgically and pathologically confirmed, were investigated with ultrasound. Echographic diagnosis was possible in 34 patients (85%): special emphasis was laid on wall thickening (90% of cases, with a mean wall thickness of 8.08 mm), evidence of an echofree layer within the wall (67.5% of patients) and a lumen greater than 4 cm with thick walls. Associated cholelithiasis was demonstrated in 28 of these patients. In five more patients specific wall signs were absent and cholelithiasis was the only detectable sign of the disease. In only one patient was there no echographic sign of acute cholecystitis.

Grey-scale ultrasonography in the evaluation of carcinoma of the gall bladder

Ultrasonography was used to evaluate 18 proven cases of carcinoma of the gall-bladder and a prospective diagnosis was correctly achieved in 88.8%. The ultrasonographic findings may be classified into primary and associated. The diagnostic role of ultrasonography is considered and a flow-chart of further investigations is suggested. The diagnostic limits for early detection are underlined.