Prevalence and significance of gallbladder abnormalities seen on sonography in intensive care unit patients

OBJECTIVE. We evaluated sonographic abnormalities of the gallbladder other than acalculous cholecystitis across a broad range of intensive care unit ( ICU) patients. SUBJECTS AND METHODS. Fifty-five consecutive patients (age range, 18-94 yea rs old; mean age, 56 years; 33 men, 22 women), who were admitted to the ICU with a variety of diagnoses, underwent sonography of the gallbladder twice a week. Patients with gallbladder calculi were excluded from the study. Th e gallbladder was examined for the recognized sonographic features of acalc ulous cholecystitis: gallbladder wall thickening, gallbladder distention, i ntramural gallbladder lucencies (striated gallbladder wall), pericholecysti c fluid, gallbladder sludge, and Murphy's sign. These findings were correla ted with clinical and laboratory parameters that are associated with acalcu lous cholecystitis: fever, WBC, liver function rests, levels of serum bilir ubin, mechanical ventilation status, and administration of parenteral nutri tion, narcotic analgesics, antibiotics, and presser agents. RESULTS. Eleven of the 55 patients were found to have gallbladder calculi a nd were excluded from the study. Thirty-seven (84%) of the remaining 44 pat ients had at least one sonographic abnormality while in the ICU. Twenty-fiv e (57%) of the 44 patients had as many as three abnormalities found on sono graphy, and six (14%) of 44 patients had four or five sonographic findings of gallbladder abnormalities while in the ICU. No statistically significant correlation was found among any of these sonographic abnormalities and the clinical and laboratory parameters. CONCLUSION. Gallbladder abnormalities are frequently seen on sonography in ICU patients. even if these patients are not suspected of having acalculous cholecystitis; therefore, sonography appears to be of limited value in dia gnosing acalculous cholecystitis in ICU patients.