Department of Radiology, Hospital Universitario 12 de Octubre, Avda de Córdoba s/n. 28041, Madrid, Spain.
Department of General Surgery, Hospital Universitario 12 de Octubre, Avda de Córdoba s/n. 28041, Madrid, Spain.
Abdom Radiol (NY). 2021 Aug;46(8):3855-3865. doi: 10.1007/s00261-021-03039-2. Epub 2021 Mar 20.
To evaluate the clinical and imaging findings of acute cholecystitis in recent lung transplant patients.
We retrospectively reviewed all abdominal ultrasounds and computed tomography (CT) scans of patients who developed acute cholecystitis in the early postoperative period following lung transplantation from November 2014 to December 2020 in a tertiary care university hospital.
Ten patients (4.4%) were included in this series (6 male, mean age 62.9 years ± 2.1 [standard deviation]) of a total 227 lung transplant patients performed from November 2014 to December 2020 (172 unilateral and 55 bilateral). Nine (90%) patients received a double-lung transplant and seven (70%) required extracorporeal circulation during surgery. Acute cholecystitis occurred during the initial admission for lung transplantation (average of 33 ± 25.9 days post-transplantation). Six patients (60%) died during admission with an average of 24.3 ± 21.8 days after cholecystectomy. The most frequent imaging findings were gallbladder wall discontinuity or decreased gallbladder mural enhancement (100%, 10 patients) and gallbladder distension (90%, 9 patients). All acute cholecystitis were found to be ischemic / gangrenous at surgery and/or pathology, 40% (4 patients) were hemorrhagic and 30% (3 patients) were perforated, one of them with a cholecystoduodenal fistula. Fungal cholecystitis was demonstrated at histological exam in one patient.
Acute cholecystitis in the early postoperative period after lung transplantation is an important cause of morbidity and mortality. Ischemic or gangrenous cholecystitis prevails. The key imaging findings are parietal perfusion defects and gallbladder distension, which can easily go unnoticed if not specifically looked for.
评估近期肺移植患者急性胆囊炎的临床和影像学表现。
我们回顾性分析了 2014 年 11 月至 2020 年 12 月期间在一家三级保健大学医院接受肺移植的患者中，早期术后发生急性胆囊炎的所有腹部超声和 CT 扫描。
该系列共纳入 10 例患者（4.4%）（6 例男性，平均年龄 62.9±2.1 岁[标准差]），共 227 例肺移植患者中，其中 172 例为单侧，55 例为双侧。9 例（90%）患者接受了双肺移植，7 例（70%）患者在手术中需要体外循环。急性胆囊炎发生在肺移植的初始入院期间（平均移植后 33±25.9 天）。6 例（60%）患者在入院期间死亡，胆囊切除术后平均 24.3±21.8 天。最常见的影像学表现为胆囊壁连续性中断或胆囊壁增强减弱（100%，10 例）和胆囊扩张（90%，9 例）。所有急性胆囊炎在手术和/或病理检查中均发现为缺血性/坏疽性，40%（4 例）为出血性，30%（3 例）为穿孔性，其中 1 例为胆囊十二指肠瘘。1 例患者在组织学检查中表现为真菌性胆囊炎。
肺移植后早期术后急性胆囊炎是发病率和死亡率的重要原因。缺血性或坏疽性胆囊炎较为常见。关键的影像学表现是壁层灌注缺陷和胆囊扩张，如果不特别注意，很容易被忽视。
