Utility of ultrasound in the differential diagnosis of acute cholecystitis.

Three case reports show the usefulness of ultrasound examination in patients with right upper quadrant masses despite clinical or roentgenographic evidence of cholecystitis or cholelithiasis. In one patient an hepatic fungal abscess from Candida albicans was distinguished from the gallbladder; in another, the same was possible for a pyogenic abscess in an old surgical incision; and in a third, extension of a gallbladder carcinoma to the liver was distinguished from the gallbladder itself. Thus, the ultrasound examination allowed assessment of the relationship between the clinically palpable mass and ultrasonically defined anatomy, When needed, increased specificity of diagnosis was obtained by ultrasonically guided fine-needle aspiration biopsy.