H. Sinatro1, M. Boltz1, E. Schaefer1, S. Armen1 1Penn State Hershey Medical Center,Surgery,Hershey, PA, USA
Introduction: Despite numerous studies examining the sensitivity and specificity of ultrasound (US), CT scan, and hepatoscintigraphy (HIDA) scan in the diagnosis of acute cholecystitis, many institutions still require two confirmatory imaging modalities prior to placing a percutaneous cholecystostomy tube in patients who are not operative candidates. The aim of this study was to determine if a single imaging modality is sufficient to make the diagnosis.
Methods: Data were collected on 163 patients at a single academic medical center who underwent percutaneous cholecystostomy tube placement from 2013-2018. Sensitivity and specificity were calculated for US, CT, and clinical data with respect to HIDA scan.
Results: US was performed in 64% of patients, CT in 74%, both US and CT were done in 48% of patients, and 38% had a HIDA scan. Of those with a positive US, 38% had a concomitant positive HIDA. 26% of patients with a positive CT had a positive HIDA. In patients with a negative ultrasound but positive clinical exam, 92% had a positive HIDA scan indicating acute cholecystitis. Combining clinical exam with either US or CT yielded a 100% specificity, while US and HIDA or CT and HIDA produced a 63% specificity.
Conclusion: While clinical findings and laboratory data raises the suspicion of acute cholecystitis, and the addition of a HIDA scan is the ultimate confirmatory test for diagnosis, consideration should be made for those patients with positive US or CT, and positive clinical data to forgo a second imaging test in order to prevent delay in performing percutaneous intervention.