Gangrenous cholecystitis: Analysis of imaging findings in histopathologically confirmed cases

• Published in: The Indian journal of radiology & imaging 2018-01, Vol.28 (1), p.49-54
• Main Authors: Sureka, Binit, Rastogi, Archana, Mukund, Amar, Thapar, Shalini, Bhadoria, Ajeet Singh, Chattopadhyay, Tushar Kanti
• Format: Article
• Language: English
• Subjects: Care and treatment; Case studies; Cholecystitis; Diagnosis; Diagnostic imaging; gallbladder distension; gangrenous; Gastrointestinal Radiology and Hepatology; membranes
• ISSN: 0971-3026; 0970-2016; 1998-3808; 0971-3026
• DOI: 10.4103/ijri.IJRI_421_16

Abstract Purpose: To study the imaging findings in gangrenous acute cholecystitis. Materials and Methods: Retrospective analysis of imaging findings in 31 histopathologically confirmed cases of gangrenous cholecystitis was done. The following imaging findings were analyzed: wall thickness, gallbladder distension, intraluminal membranes, mural striation, edema, wall enhancement, gallstones, gas, pericholecystic fluid, stranding, hemorrhage, hyperaemia in adjacent liver, mucosal/wall irregularity, complications. Statistical Analysis: Appropriate statistical tests were used using SPSS.22.0 software. The two proportions were compared using Chi-square or Fisher exact test and two means were compared using student t test. Results: Mean gallbladder wall thickening was 6 ± 1.93 mm. Gallstones, mural edema, mural striation, pericholecystic fluid, intraluminal membranes, gas were seen in 30, 27, 18, 20, 14 and 3 cases respectively. The mean short-axis distension of gallbladder lumen was 4.24 ± 0.91 cm. Gallbladder wall enhancement was studied in only 10 cases. Complete absence of enhancement was seen in 1, focal decreased enhancement in 8 cases. Mucosal/wall irregularity was seen in 28 cases. 74.2% cases had ≥4 cm gallbladder distension. Intraluminal membranes were present in 14 cases with mean short-axis distension of 4.6 cm and absent in 17 ( P = 0.041), in 11 cases with mural striation ( P = 0.036). Mean wall thickening was 6.69mm in patients with intraluminal membranes and 5.46 mm with absence of membranes ( P = .078). Conclusion: Presence of more than one of these findings - gallbladder distension (short axis diameter of ≥4 cm), intraluminal membranes, mural striation, absent or decreased enhancement of gallbladder wall suggest high probability of gangrenous change in acute cholecystitis.