Table 3.
Diagnostic criteria for acute cholecystitis
| (A) Proposed at International Meeting |
| 1. (1) Murphy’s sign, (2) RUQ, mass/pain/tenderness, (3) rigidity/muscle guarding, (4) rebound tenderness |
| 2. (1) Fever, (2) abnormal WBC count, (3) elevated CRP |
| 3. Imaging findings characteristic of acute cholecystitis |
| Suspected diagnosis: one item in 1. and one item in 2. are positive. (Suspected diagnosis may be deleted? If so, definition of definite diagnosis?) |
| Definite diagnosis: 3. is positive in patients who fulfill the criteria for suspected diagnosis |
| Note: acute hepatitis, other causes of acute abdomen, and chronic cholecystitis should be excluded |
| (B) Final version of diagnostic criteria for acute cholecystitis | |
| A. Local signs of inflammation | (1) Murphy’s sign, (2) RUQ mass/pain/tenderness |
| B. Systemic signs of inflammation | (1) Fever, (2) elevated CRP, (3) elevated WBC count |
| C. Imaging findingsa | Imaging findings characteristic of acute cholecystitis |
| Definite diagnosis | |
| (1) One item in A and one item in B are positive | |
| (2) C confirms the diagnosis when acute cholecystitis is suspected clinically | |
| Note: acute hepatitis, other acute abdominal disease, and chronic cholecystitis should be excluded | |
aImaging findings of acute cholecystitis
| Ultrasonography | |
| • | Sonographic Murphy sign (tenderness elicited by pressing the gallbladder with the ultrasound probe) |
| • | Thickened gallbladder wall (>4 mm, if the patient does not have chronic liver disease and/or ascites or right heart failure) |
| • | Enlarged gallbladder (long axis diameter >8 cm, short axis diameter >4 cm) |
| • | Incarcerated gallstone, debris echo, pericholecystic fluid collection |
| • | Sonolucent layer in the gallbladder wall, striated intramural lucencies, and Doppler signals |
| MRI | |
| • | Pericholecystic high signal |
| • | Enlarged gallbladder |
| • | Thickened gallbladder wall |
| CT | |
| • | Thickened gallbladder wall |
| • | Pericholecystic fluid collection |
| • | Enlarged gallbladder |
| • | Linear high-density areas in the pericholecystic fat tissue |
| Tc-HIDA scan (technetium hepatobiliary iminodiacetic acid scan) | |
| • | Non-visualized gallbladder with normal uptake and excretion of radioactivity |
| • | Rim sign (augmentation of radioactivity around the gallbladder fossa) |