One study states that gallbladder ejection fraction <30% may be useful in predicting the severity of cholecystitis and is associated with a higher complication rate in the setting of laparoscopic cholecystectomy [39]. However, although cholescintigraphy has a higher sensitivity and specificity for the evaluation of AC, US remains the initial test of choice for imaging patients with right upper quadrant pain for a variety of reasons, including shorter study time, morphologic evaluation, confirmation of the presence or absence of gallstones, evaluation of intrahepatic and extrahepatic bile ducts, and identification or exclusion of alternative diagnoses [15-17,40]. US Abdomen US is the first choice of investigation for biliary symptoms or right upper quadrant abdominal pain. It is very accurate at diagnosing or excluding gallstones, with reported accuracy of 96% for the detection of gallstones [7], and may differentiate cholelithiasis from gallbladder sludge, polyps, or masses. The diagnosis of chronic cholecystitis is difficult on anatomic imaging. The gallbladder may appear contracted or distended, and pericholecystic fluid is usually absent. An initial study from 1981 defined the sonographic Murphy sign as focal tenderness corresponding to a sonographically localized gallbladder, which, along with stones, sludge, and gallbladder wall thickening, allowed for differentiating AC from gallstones alone and chronic cholecystitis with gallstones [40]. Unfortunately, the Right Upper Quadrant Pain sonographic Murphy sign has a relatively low specificity for AC [41], and its absence is unreliable as a negative predictor of AC if the patient has received pain medication before imaging. Since that initial study, many subsequent studies have been conducted to assess the accuracy of US and cholescintigraphy. A meta-analysis by Shea et al [42] reviewed 22 studies evaluating cholescintigraphy and 5 studies evaluating US published between 1978 and 1990.
Right Upper Quadrant Pain. One study states that gallbladder ejection fraction <30% may be useful in predicting the severity of cholecystitis and is associated with a higher complication rate in the setting of laparoscopic cholecystectomy [39]. However, although cholescintigraphy has a higher sensitivity and specificity for the evaluation of AC, US remains the initial test of choice for imaging patients with right upper quadrant pain for a variety of reasons, including shorter study time, morphologic evaluation, confirmation of the presence or absence of gallstones, evaluation of intrahepatic and extrahepatic bile ducts, and identification or exclusion of alternative diagnoses [15-17,40]. US Abdomen US is the first choice of investigation for biliary symptoms or right upper quadrant abdominal pain. It is very accurate at diagnosing or excluding gallstones, with reported accuracy of 96% for the detection of gallstones [7], and may differentiate cholelithiasis from gallbladder sludge, polyps, or masses. The diagnosis of chronic cholecystitis is difficult on anatomic imaging. The gallbladder may appear contracted or distended, and pericholecystic fluid is usually absent. An initial study from 1981 defined the sonographic Murphy sign as focal tenderness corresponding to a sonographically localized gallbladder, which, along with stones, sludge, and gallbladder wall thickening, allowed for differentiating AC from gallstones alone and chronic cholecystitis with gallstones [40]. Unfortunately, the Right Upper Quadrant Pain sonographic Murphy sign has a relatively low specificity for AC [41], and its absence is unreliable as a negative predictor of AC if the patient has received pain medication before imaging. Since that initial study, many subsequent studies have been conducted to assess the accuracy of US and cholescintigraphy. A meta-analysis by Shea et al [42] reviewed 22 studies evaluating cholescintigraphy and 5 studies evaluating US published between 1978 and 1990.