Imaging cholecystitis - Quo Vadis

260 patients had sup(99m)Tc-HIDA (2,6,-dimethyl-acetanlide-iminodiacetic acid) or sup(99m)Tc-PIPIDA (p-isopropyl-acetanalide-iminodiacetic acid) cholescintiscans and cholecystosonograms from 4-1-78 to 10-31-81. 114 patients had gallblader surgery, and of these only 94 cases who showed common bile duct with spillage of activity into the intestines with or without gallbladder visualization in 60 minutes on cholescintigraphy were included in this study. The following results were emphasized: (1) cholescintiscans can be normal or abnormal in chronic cholecystitis. (2) A normal cholescintiscan rules out acute cholecystitis. (3) If acute cholecystitis is a differential consideration in the work-up of right upper quadrant pain, cholescintiscan is the imaging procedure of choice as a normal study excludes it. (4) An abnormal cholescintiscan is not pathognomonic of acute cholecystitis but does indicate a diseased gallbladder. (5) If the clinical diagnosis is acute or chronic cholecystitis, cholescintiscan is not recommended if cholecystosonogram shows cholelithiasis but may be indicated if stones are not present