Acute cholecystitis: sonographic-pathologic analysis.

The study was performed to assess the pathogenic basis of sonographically demonstrable changes in the gallbladder wall in acute cholecystitis in an attempt to predict the degree of inflammation and to define a set of sonographic criteria for the diagnosis of acute cholecystitis. Sonograms in a control group of 30 patients (group A) without biliary tract symptoms, ascites, or cholelithiasis and 24 patients (group B) with proven diagnosis of acute cholecystitis were reviewed. The histologic sections of the gallbladder wall in the cholecystitis patients were correlated with sonographic findings. None of the gallbladders showed perforation at the time of pathologic evaluation. Data failed to show a correlation between the pathologic severity of the inflammatory process in the gallbladder wall and the degree of sonographic wall thickening and wall anechoicity. Of patients with acute cholecystitis, 70% met all of the following sonographic criteria: (1) gallbladder wallthickening of 5 mm or greater, (2) gallbladder wall anechoicity, (3) gallbladder distension, as determined by an external anteroposterior width of 4 cm or greater, and (4) cholelithiasis.