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#3

ANSWER B.

This patient has suspected acute cholecystitis and requires an imaging study for confirmation. Hepatobiliary iminodiacetic acid (HIDA) scanning is considered to be the most sensitive and specific test for diagnosing acute cholecystitis. IDA is administered intravenously, taken up by hepatocytes, and excreted into the bile canaliculi. Failure to obtain an outline of the gallbladder within 1 hour proves cystic duct obstruction and, in the appropriate clinical setting confirms the diagnosis of acute cholecystitis. Visualization of the gallbladder and common duct within 1 hour has a high negative predictive value. A HIDA scan is usually obtained when the ultrasound study is equivocal.

Computed tomography scan with intravenous contrast (A) can identify cholecystitis with a reported sensitivity of 92% and specificity of 99%.  It is most useful in cases of emphysematous and hemorrhagic cholecystitis. MRI with gadolinium (C) provided similar diagnostic yield to CT scan. Ultrasound (D) is most useful in the ED setting as it is a quick, non-invasive test.  Its sensitivity and specificity, however, are lower than a HIDA scan for pathology confirmed cholecystitis. Ultrasound findings and a clinical exam consistent with acute cholecystitis are highly predictive and many such patients will undergo cholecystectomy without any further diagnostic testing.

Ref
Guss DA, Oyama LC: Disorders of the Liver and Biliary Tract, in Marx JA, Hockberger RS, Walls RM, et al (eds): Rosen’s Emergency Medicine: Concepts and Clinical Practice, ed 7. St. Louis, Mosby, Inc., 2010, (Ch) 88:p 1153-1171

>>GO TO QUESTION 4

 

 

Comments   

# Mini Board Review: March 2013 EditionDiane Gilliland 2013-03-07 20:37
Thank you for putting together the questions for the mini board review. I find them very helpful!
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# Mini Board reviewDr Zahn 2013-03-10 09:37
Good review....but alot of medical info, very specific...not known when you are out for years in practice.
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# MDSam Morale 2013-03-11 17:06
Thanks for your effort. Nice to review uncommon diseases to keep us up to speed. It is amazing how many diseases, pathogens etc... have had their names changed : Granulomatosis with Polyangiitis (GPA) (formerly referred to as Wegener’s granulomatosis) .
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# Robert Ditrolio 2013-03-12 17:10
Excellent review questions. Please keep them coming in future issues!
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