Ultrasonography and color Doppler contrast-enhanced imaging of the gallbladder in intensive care unit patients: an early diagnosis of acute acalculous cholecystitis

Patients in the ICU are at risk of developing acute acalculous cholecystitis (AAC). The disease carries high morbidity and mortality rates partly because of the difficulties of diagnosis.

To evaluate the morphology and vascularity of the gallbladder in ICU patients examined by ultrasonography (US) and color Doppler (CD) and contrast-enhanced (CE) study. To assess the value of the method in the diagnosis of AAC.

We prospectively examined 50 concecutive patients who were admitted to the ICU with a variety of diagnoses. The patients were examined 7 days after admission to the ICU. Follow-up examinations were performed every 7–10 days. A total of 98 examinations were obtained in 50 patients. In each examination, the gallbladder was examined by US, CD and CE study with galactose-based microbubbles (SHU 508 A Levovist). Sonographic parameters were obtained (distention, wall thickening, containts, pericholecyctic fluid pericholecyctic edema) and vascularity (normal, abnormal flow signals) was estimated. The findings correlated with clinical and laboratory parameters and histology if cholecystectomy was performed.

Four out of 50 patients (8%) had one sonographic abnormality while they were in the ICU, 7/50 (14%) had two abnormalities, 11/50 (22%) had three abnormalities, 22/50 had four or more abnormalities and only 6/50 (12%) had no sonographic abnormality. In 2/50 (4%) hypervascularisation was detected in CD and CE study. Only these two patients had surgically proved AAC.

GB abnormalities are frequently seen on US in ICU patients even if these patients are not suffering AAC. The sonographic critiria are not specific. CD imaging, especially after CE imaging, is useful for the detection hyperemia in the acute stage of GB inflammation and may improve the accuracy of the method in early diagnosis of AAC.