SONOMORPHOLOGY OF THE GALLBLADDER IN CRITICAL ILL PATIENTS - VALUE OFA SCORING SYSTEM AND FOLLOW-UP EXAMINATIONS

Purpose: The aim of the study was to assess the value of a scoring sys tem for the diagnosis of acalculous cholecystitis (AC) on ultrasound ( US) follow-up examinations and to discuss the merits of a scoring syst em compared to clinical outcome and pathohistologic findings. Material and Methods. In this prospective study, 21 patients at the intensive care unit (ICU) of a medical department were examined by follow-up US. Sonographic parameters of the gallbladder (GB) were obtained (longitu dinal and transversal diameter, wall thickening, contents, and pericho lecystic fluid) and scored (2 points: distension of GB, thickening of GB wall; 1 point: striated thickening of GB wall, sludge, and perichol ecystic fluid; range (0-8)). The US findings were correlated with clin ical findings and histology at cholecystectomy or autopsy. Results: Of a total of 77 follow-up examinations in these 21 patients, US demonst rated GB distension in 19 patients, wall thickening in 18, sludge in 1 5, striated thickening of the GB wall in 13, and pericholecystic fluid in 12 patients. Of these, 41 (53%) examinations were scored greater t han or equal to 6, and 36 (47%) examinations less than or equal to 5. None of the patients with a maximum score during follow-up of less tha n or equal to 5 (n=8) had pathohistologic proof of AC or died due to G B complications. Patients with maximum scores of greater than or equal to 6: had pathohistologic proof of AC (n=4); survived with normalizat ion of GB morphology (n=4); had a normal GB at autopsy (n=1); or were lost for pathohistologic proof at autopsy (n=2). Conclusion: Our resul ts indicate that regular, short-term follow-up allows early diagnosis and immediate therapy for AC. The scoring system could be helpful in d ifferentiating between patients with an abnormal GB without AC (score less than or equal to 5) and these with an abnormal GB (score greater than or equal to 6) with a suspicion of AC. In the latter group, more aggressive diagnostic and therapeutic procedures may be indicated.