Intravenous cholecystography and ultrasonography in the diagnosis of acute cholecystitis. A prospective comparative study.

In a consecutive series of 120 patients with clinically suspected acute cholecystitis, intravenous cholecystography and gray scale sonography were performed for comparative evaluation in a prospective study. Acute cholecystitis was diagnosed in 71 patients and gallstones without signs of acute cholecystitis in 12, while in 37 patients no gallstone disease could be detected. Intravenous cholecystography could not be performed in 28 cases because of jaundice, iodine allergy or pregnancy, and in ten other patients there was no proof of hepatic excretion of the contrast medium. Though the results in the cases with interpretable cholecystograms were excellent, the clinical usefulness was only 68%. Ultrasonography was feasible in all cases and the accuracy was 93%. Ultrasonography has the additional advantages of noninvasiveness and no irradiation problems. Sonographic findings such as thickening of the gallbladder wall, distension, and tenderness on compression of the gallbladder were diagnostically helpful in acalculous cholecystitis and in distinguishing between acute and chronic gallbladder disease. Ultrasonography is recommended as the initial screening procedure in suspected acute cholecystitis.