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  • Title: Calculous cholecystitis and hepatic cirrhosis as sonographic co-confounders for gallbladder evaluation.
    Author: Sohail S, Shaheen R, Khatri ZA.
    Journal: J Coll Physicians Surg Pak; 2006 Nov; 16(11):693-5. PubMed ID: 17052417.
    Abstract:
    OBJECTIVE: To compare the sonographic features of gallbladder in symptomatic calculous cholecystitis and cirrhosis with silent cholelithiasis. DESIGN: Cross-sectional, observational study. DURATION: From October 2003 to May 2005. SETTING: Radiology Department, Dow University of Health Sciences and Civil Hospital (DUHS/CHK), Karachi. METHODOLOGY: Two hundred adult patients of both genders were studied after dividing into two groups. Group A had clinically suspected calculous cholecystitis and group B had patients from outpatient department and medical wards with clinical diagnosis of cirrhosis, with incidentally diagnosed cholelithiasis. The sonographic features of gallbladder were determined and compared. Significance was computed for the sonographic variables including morphological features as well as demographic features by Chi-square and t-test, keeping significance at p< .001 RESULTS: Group A (with calculous cholecystitis) had 100 patients with mean age of 47 +/- 3.2 years with 71 females. Group B (cirrhosis with silent cholelithiasis) comprised of 100 patients with mean age of 38 +/-4.2 years with 58 females. Among them, 54 were hepatitis C virus(HCV) positive, 38 had positive serology for Hepatitis B virus (HBV) positive and 08 had positive serology for both. Both groups had more multiple than single calculi. The average size of the largest calculus was 1.5 cm in group A and 1.2 cm in the group B. The mean gallbladder wall thickness was greater in cirrhotic than in the other group (4.9 vs. 4.2 cm, p-value 0.7). Gallbladder wall irregularity was significantly more common in group B than in group A (57 vs. 25 mm, p=0.001). The pericholecystic fluid layer thickness was significantly greater in the cirrhotic group (18.5 +7.1 vs. 5.7 +1.8 mm, p< 0.001). Positive sonographic Murphy's sign was positive in 89% calculous cholecystitis cases and 77% of the cirrhotic group. CONCLUSION: The sonographic findings of thickened wall of the gallbladder with pericholecystic fluid and positive sonographic Murphy's sign are common in both calculous cholecystitis and in asymptomatic cholelithiasis with cirrhosis. However, in the present series, those with cholecystitis had statistically significant greater irregularity of gallbladder wall and majority of those with cirrhosis had a significantly greater thickness of wall and a pericholecystic layer in excess of 1 cm.
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