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Follow‐up sonography in suspected acalculous cholecystitis: preliminary clinical experience

Fourteen adult patients with clinically suspected AAC and inconclusive initial sonograms underwent follow‐up sonography within 24 hours. Eight patients had initial studies demonstrating a normal thickness of the gallbladder wall. Four of these patients demonstrated progressive thickening of the gallbladder wall on follow‐up scans and were diagnosed as having AAC. In three of these patients AAC was proved at surgery, and the remaining patient improved clinically after percutaneous cholecystostomy. Four other patients with normal gallbladder wall thickness on both the initial and follow‐up sonograms had benign clinical follow‐up results without evidence of AAC. The remaining six patients had a thickened gallbladder on the initial sonogram. In one of these patients, the gallbladder wall thickening resolved on follow‐up sonography. In the remaining five patients the gallbladder wall thickening did not change. Four of these patients had benign follow‐up results but one patient was found to have AAC at surgery. Follow‐up sonography may be helpful to confirm AAC if there is progressive edema of the gallbladder wall. A normal gallbladder wall on an initial study does not exclude early AAC. Thickening of the gallbladder wall on initial studies still remains a problem and other ancillary criteria must be used to establish the diagnosis of AAC.