Can acute cholecystitis be diagnosed without gallbladder wall thickening, pericholecystic fluid/wall edema, or a sonographic Murphy’s sign?

 

Because of its widespread availability and high diagnostic accuracy, ultrasound is generally considered the initial test of choice for gall bladder disease evaluation

The classic ultrasound findings of cholecystitis include a sonographic Murphy’s sign, a thickened gallbladder wall, gallbladder wall edema, gallbladder hydrops, and pericholecystic fluid.  

Stone in the neck (SIN), defined as an immobile stone lodged in the neck of the gallbladder without anechoic space between the neck and stone it contains has been found to be highly suggestive of cholecystitis even in the absence of any other ultrasonographic signs of infection.  

The sensitivity of the SIN phenomenon was 56.52%. The specificity was 97.06% (84.67–99.93). The positive and negative predictive values were 92.86% (66.13–99.82) and 76.74% (61.37–88.24), respectively.

References:

Nelson, M., Ash, A., Raio, C. et al. Stone-In-Neck phenomenon: a new sign of cholecystitis. Crit Ultrasound J 3, 115–117 (2011). https://doi.org/10.1007/s13089-011-0071-6