McCORT J J
Calif Med. 1959 Feb;90(2):139-43.
In a recent series of 26 pathologically proven cases of acute cholecystitis, preoperative radiographic examination of the abdomen confirmed the presence of an inflammatory process in 17. The radiographic signs associated with acute suppurative cholecystitis are:1. Enlargement of the gallbladder, as indicated by separation or alteration in position of opaque calculi or indentation of adjacent bowel.2. Localized peritoneal irritation, manifested by (a) ileus of hepatic flexure of colon; (b) ileus of duodenal loop; (c) effacement of haustra of the hepatic flexure or valvulae conniventes of the duodenum; (d) obscuration of fat line marking inferior border of liver.3. Cholecystitis emphysematosa.4. Perforation of gallbladder, which if localized (retroperitoneal) is manifested by bubbles of gas in the gallbladder bed. If generalized (intraperitoneal) the signs are adynamic ileus of small and large bowel, increased intraperitoneal fluid, subdiaphragmatic abscess and plate atelectasis of right lung base. Visualization of the gallbladder and biliary tree after intravenous cholecystography rarely occurred in the presence of acute cholecystitis. Plain film examination of the abdomen aids in establishing the diagnosis of an acute cholecstitis and leads to the early recognition of complications such as perforation and peritonitis.
在最近一组经病理证实的26例急性胆囊炎病例中，术前腹部X线检查证实17例存在炎症过程。与急性化脓性胆囊炎相关的X线征象有：1. 胆囊增大，表现为不透X线结石的分离或位置改变，或邻近肠管受压。2. 局限性腹膜刺激，表现为：(a) 结肠肝曲肠梗阻；(b) 十二指肠袢肠梗阻；(c) 结肠肝曲袋状皱襞或十二指肠环状襞消失；(d) 肝脏下缘脂肪线模糊。3. 气肿性胆囊炎。4. 胆囊穿孔，若为局限性（腹膜后），表现为胆囊床内气体气泡；若为弥漫性（腹腔内），征象为小肠和大肠动力性肠梗阻、腹腔内液体增多、膈下脓肿及右肺底部盘状肺不张。急性胆囊炎时，静脉胆囊造影很少能显示胆囊和胆管树。腹部平片检查有助于急性胆囊炎的诊断，并能早期发现穿孔和腹膜炎等并发症。
