Acute Cholecystitis Detected By Serial Emergency Department Focused Right Upper Quadrant Ultrasound

Authors: David Bosch, Jessica N. Schmidt, John Kendall

Abstract:

Acute cholecystitis is a common etiology of acute right upper quadrant pain in patients presenting to the emergency department (ED). The use of ED-focused right upper quadrant ultrasound (RUQ US) is becoming more widely utilized to evaluate abdominal pain thought to be hepatobiliary in nature. We describe a case series of two patients with acute cholecystitis detected by serial ED-focused RUQ US. Case 1: A woman presented to the ED with epigastric pain of acute onset. She was initially found to have a mild leukocytosis and cholelithiasis detected by ED-focused RUQ US. Seventy-five minutes later, the patient had a repeat bedside ultrasound by the same sonographer that showed visual evidence of acute cholecystitis that was later confirmed by surgical pathology. She was treated operatively. Case 2: A man with known cholelithiasis presents to the ED with acute-onset RUQ pain. Initial RUQ ultrasound performed by the Department of Radiology (University of Colorado Hospital) was equivocal, showing cholelithiasis with a mildly thickened wall and no pericholecystic fluid. A repeat ED-focused RUQ ultrasound 5 hours later showed increased wall thickness and pericholecystic fluid. The patient was subsequently taken for same-day cholecystectomy. This case series demonstrates the dynamic and progressive nature of acute cholecystitis detected by ED-focused RUQ US. It also highlights how serial bedside ultrasonography can reduce harm, appropriately triage patients with hepatobiliary disease and lead to reductions in overall morbidity.

Keywords

Cholecystitis; emergency medicine; ultrasound

Citation: David Bosch, Jessica N. Schmidt, John Kendall Acute Cholecystitis Detected By Serial Emergency Department Focused Right Upper Quadrant Ultrasound doi:10.1016/j.jmu.2016.03.004

Received: 15 February 2016, Accepted: 10 March 2016, Available online: 19 April 2016

Copyright: © 2016 Elsevier Taiwan LLC and the Chinese Taipei Society of Ultrasound in Medicine. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).

Conflicts of interest: None

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