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US-guided Percutaneous Cholecystostomy: Features Predicting Culture-Positive Bile and Clinical Outcome¹

¹ From the Department of Radiology, Beth Israel Deaconess Medical Center, Harvard Medical School, 1 Deaconess Rd, Boston, MA 02215. From the 2002 RSNA scientific assembly. Received January 23, 2003; revision requested April 11; final revision received July 7; accepted August 22. Address correspondence to R.A.K. (e-mail: rkane@bidmc.harvard.edu).

View larger version (34K): [in a new window]   Figure 1. Scoring system of parameters assessed with sonograms.

View larger version (133K): [in a new window]   Figure 2a. US images obtained after 2 days of generally deteriorating condition and right upper quadrant tenderness, with no fever, in an 86-year-old woman with dementia and severe congestive heart failure. Multiple sagittal US images demonstrate the US scoring system: (a) mildly thickened edematous wall indicated by calipers (score = 3); (b) distended gallbladder (score = 4), with calipers indicating stone at the neck (score = 4); (c) pericholecystic fluid, indicated by calipers (score = 3); and (d) common bile duct dilated to 9 mm (arrow) (score = 2). The total US score is 16.

View larger version (146K): [in a new window]   Figure 2b. US images obtained after 2 days of generally deteriorating condition and right upper quadrant tenderness, with no fever, in an 86-year-old woman with dementia and severe congestive heart failure. Multiple sagittal US images demonstrate the US scoring system: (a) mildly thickened edematous wall indicated by calipers (score = 3); (b) distended gallbladder (score = 4), with calipers indicating stone at the neck (score = 4); (c) pericholecystic fluid, indicated by calipers (score = 3); and (d) common bile duct dilated to 9 mm (arrow) (score = 2). The total US score is 16.

View larger version (159K): [in a new window]   Figure 2c. US images obtained after 2 days of generally deteriorating condition and right upper quadrant tenderness, with no fever, in an 86-year-old woman with dementia and severe congestive heart failure. Multiple sagittal US images demonstrate the US scoring system: (a) mildly thickened edematous wall indicated by calipers (score = 3); (b) distended gallbladder (score = 4), with calipers indicating stone at the neck (score = 4); (c) pericholecystic fluid, indicated by calipers (score = 3); and (d) common bile duct dilated to 9 mm (arrow) (score = 2). The total US score is 16.

View larger version (148K): [in a new window]   Figure 2d. US images obtained after 2 days of generally deteriorating condition and right upper quadrant tenderness, with no fever, in an 86-year-old woman with dementia and severe congestive heart failure. Multiple sagittal US images demonstrate the US scoring system: (a) mildly thickened edematous wall indicated by calipers (score = 3); (b) distended gallbladder (score = 4), with calipers indicating stone at the neck (score = 4); (c) pericholecystic fluid, indicated by calipers (score = 3); and (d) common bile duct dilated to 9 mm (arrow) (score = 2). The total US score is 16.