Pediatric Acute Cholecystitis

Etiology: Gallstones causing obstruction of the biliary tree
Imaging US:
— Gallbladder wall thickening
— Pericholecystic fluid and edema
— Gallstones
— Sonographic Murphy’s sign
— Often an obstructing gallstone is seen in cystic duct
DDX:
Complications:
Treatment: Surgical
Clinical: Right upper quadrant pain

Radiology Cases of Acute Cholecystitis

CT and US of acute cholecystitis — Axial (above left) and sagittal (above right) CT with contrast of the abdomen shows an enlarged gallbladder with diffuse wall thickening and pericholecystic fluid. Transverse (below left) and sagittal (below right) US of the abdomen again shows gallbladder wall thickening and pericholecystic fluid and a large amount of sludge in the gall bladder.

CT and US of acute cholecystitis — Axial CT with contrast of the abdomen (above) shows a distended gall bladder with gallbladder wall thickening with rim enhancement. Sagittal US of the gallbladder shows diffuse wall thickening of the gallbladder (below left) along with a stone in the neck of the gallbladder causing posterior acoustic shadowing (below right).

US of pediatric acute cholecystitis due to gall stone in the cystic duct — Sagittal US of the gallbladder (above) shows the gallbladder wall is thickened. The gallbladder is filled with sludge and there is a cresenteric echogenic object within the lumen of the gallbladder that has posterior shadowing. Sagittal US of the gallbladder neck (below) shows the gallbladder is filled with sludge and there is a cresenteric echogenic object within the neck of the gallbladder that has posterior shadowing.