Biliary - Cholecystitis
Caption
This still image shows two clear signs of acute cholecystitis. The gallbladder wall is thickened and there is pericholecystic fluid. Of note, when measuring the gallbladder wall it's better to measure the anterior wall as the posterior wall can appear enlarged due to artifact. The cut off for wall thickening is 3mm. The anterior wall is thickened in this case but is not labeled. Other signs to look for are stones, sludge, common bile duct dilatation, and overall gallbladder enlargement. Of note, a positive sonographic Murphy's carries a sensitivity of 63%, specificity of 93.6% and positive predictive value of 72.5%. Justin Bowra MBBS, FACEM, CCPU Emergency Physician, RNSH et al. (Sharon)