Sonographic Score of Helbich et al for Acalculous Cholecystitis in a Critically Ill Patient

Sonographic views of the gallbladder:

(1) longitudinal extent (maximum longitudinal diameter)

(2) transverse width (maximum transverse diameter perpendicular to longitudinal axis)

(3) wall thickness in the anterior free wall

(4) wall thickness in the gallbladder bed

(5) gallbladder contents

(6) pericholecystic fluid

Parameters:

(1) distension of the gallbladder (GB)

(2) thickness of the gallbladder wall

(3) sludge

(4) striated thickening of the gallbladder wall

(5) pericholecystic fluid collection

where:

• Sludge was identified as echogenic bile.

• On page 130 distension of the gallbladder was defined as a longitudinal extent of >= 8 cm and transverse diameter <= 5 cm. I would have thought that >= 5 cm seems more like distention; in Table 2 the maximum transverse diameter is given as 7.9 cm.

total score =

= SUM(points for all 5 parameters)

Interpretation:

• minimum score: 0

• maximum score: 8

• A score >= 6 is suspicious for acalculous cholecystitis.