Radiographic signs of acute suppurative cholecystitis.

In a recent series of 26 pathologically proven cases of acute cholecystitis, preoperative radiographic examination of the abdomen confirmed the presence of an inflammatory process in 17. The radiographic signs associated with acute suppurative cholecystitis are:1. Enlargement of the gallbladder, as indicated by separation or alteration in position of opaque calculi or indentation of adjacent bowel.2. Localized peritoneal irritation, manifested by (a) ileus of hepatic flexure of colon; (b) ileus of duodenal loop; (c) effacement of haustra of the hepatic flexure or valvulae conniventes of the duodenum; (d) obscuration of fat line marking inferior border of liver.3. Cholecystitis emphysematosa.4. Perforation of gallbladder, which if localized (retroperitoneal) is manifested by bubbles of gas in the gallbladder bed. If generalized (intraperitoneal) the signs are adynamic ileus of small and large bowel, increased intraperitoneal fluid, subdiaphragmatic abscess and plate atelectasis of right lung base. Visualization of the gallbladder and biliary tree after intravenous cholecystography rarely occurred in the presence of acute cholecystitis. Plain film examination of the abdomen aids in establishing the diagnosis of an acute cholecstitis and leads to the early recognition of complications such as perforation and peritonitis.