Ultrasound Criteria for Acute Cholecystitis: Sonographic Murphy's Sign, Wall Thickness, Perivesicular Fluid
Main Sonographic Criteria
Acute cholecystitis is characterized by very specific findings on ultrasound examination (Textbook of Diagnostic Sonography, 9th ed., 2023):
- Positive Sonographic Murphy's Sign — the gallbladder area becomes extremely sensitive to touch (compression with the transducer).
- Wall Thickening >3 mm — measured along the anterior wall when positioned parallel to the transducer.
- Lumen Distension >4 cm — an enlarged (distended) gallbladder.
Additional Signs
According to Diagnostic Ultrasound: Abdomen & Pelvis (2nd ed., 2022), acute cholecystitis on transverse scanning is accompanied by:
- dependent gallstones and sludge;
- wall thickening;
- inflammatory, echogenic perivesicular fat (fat tissue infiltration).
On CEUS of the same patient, a distended gallbladder with a thickened wall, dependent gallstones and sludge, as well as inflammatory infiltration of perivesicular fat is visualized.
Summary of Criteria
| Sign | Value |
|---|---|
| Sonographic Murphy's Sign | Positive |
| Wall Thickness | >3 mm (along the anterior wall, parallel to the transducer) |
| Lumen (Distension) | >4 cm |
| Contents | Dependent gallstones, sludge |
| Perivesicular Fat | Inflammatory echogenic infiltration |
Complications
Complications of acute cholecystitis can be serious and include empyema, emphysematous or gangrenous cholecystitis, and perforation (Textbook of Diagnostic Sonography, 9th ed., 2023). Antibiotics may be prescribed before surgery to reduce inflammation. Contrast-enhanced ultrasound (CEUS) is useful in diagnosing acute gangrenous cholecystitis [clarify] — based on comparative data with surgical and pathological findings (Ripollés T et al., Eur J Radiol, 2016).
Frequently asked questions
How should the gallbladder wall thickness be measured?
Along the anterior wall, when positioned parallel to the transducer; the criterion for thickening is >3 mm (Textbook of Diagnostic Sonography, 2023).
What is the sonographic Murphy's sign?
Extreme sensitivity (tenderness) of the gallbladder area to compression with the transducer; a positive sign is indicative of acute cholecystitis.
What lumen size indicates gallbladder distension?
A distended lumen >4 cm (Textbook of Diagnostic Sonography, 2023).
What changes in perivesicular fat are characteristic?
Inflammatory echogenic infiltration of fat tissue medially; on CEUS — inflammatory stranding of perivesicular fat tissue (Diagnostic Ultrasound: Abdomen & Pelvis, 2022).
What complications of acute cholecystitis should be excluded?
Empyema, emphysematous or gangrenous cholecystitis, perforation; CEUS is useful in the gangrenous form (Textbook of Diagnostic Sonography, 2023; Ripollés T et al., 2016).