Multidetector Computed Tomography (MDCT) Findings of Complications of Acute Cholecystitis. A Pictorial Essay

• Published in: Tomography (Ann Arbor) Vol. 8; no. 2; pp. 1159 - 1171
• Main Authors: Sandomenico, Fabio, Sanduzzi, Luca, La Verde, Emilia, Vicenzo, Emilio, Pirolo, Luigi, Maione, Salvatore, Setola, Francesca Rosa, Macchia, Valeria, Dello Iacono, Umberto, Barbato, Domenico, Peluso, Gaia, Santangelo, Michele, Brunetti, Arturo
• Format: Journal Article
• Language: English
• Published: Switzerland MDPI 18.04.2022; MDPI AG
• Subjects: Abdominal Pain - complications; abscess; aneurysm; cholangitis; Cholecystitis - complications; Cholecystitis - diagnostic imaging; Cholecystitis, Acute - complications; Cholecystitis, Acute - diagnostic imaging; colitis; computed tomography; Humans; Multidetector Computed Tomography - adverse effects; pancreatitis; Review; Ultrasonography - adverse effects; computed tomography; aneurysm; portal thrombosis; colitis; pseudoaneurysm; pancreatitis; cholangitis; abscess; pylephlebitis
• ISSN: 2379-139X; 2379-1381; 2379-139X
• DOI: 10.3390/tomography8020095

Acute cholecystitis stands out as one of the most common surgical pathologies that should always be considered in a right-upper abdominal pain emergency. For this, the importance of a correct diagnosis is well described. However, it has been demonstrated that the simple combination of clinical (pain, Murphy's sign) and laboratory (leukocytosis) parameters alone does not provide for ruling in or ruling out the diagnosis of this condition, unless accompanied by a radiological exam. For a long time, and still today, ultrasonography (US) is by far the first-to-proceed radiologic exam to perform, thanks to its rapidity and very high sensibility and specificity for the diagnosis of simple acute cholecystitis. However, acute cholecystitis can undergo some complications that US struggles to find. In addition to that, studies suggest that multidetector computed tomography (MDCT) is superior in showing complicated forms of cholecystitis in relation to sensibility and specificity and for its capability of reformatting multiplanar (MPR) reconstructions that give a more detailed view of complications. They have shown to be useful for a precise evaluation of vascular complications, the anatomy of the biliary tree, and the extension of inflammation to surrounding structures (i.e., colitis). Therefore, based also on our experience, in patients with atypical presentation, or in cases with high suspicion for a complicated form, a MDCT abdomen scan is performed. In this review, the principal findings are listed and described to create a CT classification of acute complications based on anatomical and topographic criteria.