Charalel Resmi A, Jeffrey R Brooke, Shin Lewis K
Stanford University School of Medicine, Stanford University Medical Center, Stanford, CA, USA.
Ultrasound Q. 2011 Sep;27(3):161-70. doi: 10.1097/RUQ.0b013e31822a33e8.
Acute cholecystitis is a common cause of abdominal pain in the Western world. Unless treated promptly, patients with acute cholecystitis may develop complications such as gangrenous, perforated, or emphysematous cholecystitis. Because of the increased morbidity and mortality of complicated cholecystitis, early diagnosis and treatment are essential for optimal patient care. Nevertheless, complicated cholecystitis may pose significant challenges with cross-sectional imaging, including sonography and computed tomography (CT). Interpreting radiologists should be familiar with the spectrum of sonographic findings seen with complicated cholecystitis and as well as understand the complementary role of CT. Worrisome imaging findings for complicated cholecystitis include intraluminal findings (sloughed mucosa, hemorrhage, abnormal gas), gallbladder wall abnormalities (striations, asymmetric wall thickening, abnormal gas, loss of sonoreflectivity and contrast enhancement), and pericholecystic changes (echogenic fat, pericholecystic fluid, abscess formation). Finally, diagnosis of complicated cholecystitis by sonography and CT can guide alternative treatments including minimally invasive percutaneous and endoscopic options.
在西方世界，急性胆囊炎是腹痛的常见病因。除非及时治疗，急性胆囊炎患者可能会出现诸如坏疽性、穿孔性或气肿性胆囊炎等并发症。由于复杂性胆囊炎的发病率和死亡率增加，早期诊断和治疗对于实现最佳的患者护理至关重要。然而，复杂性胆囊炎在超声和计算机断层扫描（CT）等横断面成像中可能带来重大挑战。解读影像的放射科医生应熟悉复杂性胆囊炎的超声表现谱，并了解CT的辅助作用。复杂性胆囊炎令人担忧的影像表现包括腔内表现（脱落的黏膜、出血、异常气体）、胆囊壁异常（条纹状、不对称壁增厚、异常气体、声反射消失和对比增强）以及胆囊周围改变（回声增强的脂肪、胆囊周围积液、脓肿形成）。最后,通过超声和CT诊断复杂性胆囊炎可指导包括微创经皮和内镜治疗在内的替代治疗。
