The sonographic diagnosis of acute gangrenous cholecystitis: importance of the Murphy sign |
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Authors: | J F Simeone J A Brink P R Mueller C Compton P F Hahn S Saini S G Silverman G Tung J T Ferrucci |
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Affiliation: | Department of Radiology, Massachusetts General Hospital, Boston 02114. |
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Abstract: | The sonographic Murphy sign is defined as the presence of maximal tenderness elicited by direct pressure of the transducer over a sonographically localized gallbladder. The reported prevalence of this sign is more than 95% in patients with acute cholecystitis. In this series of 18 patients with pathologically proved gangrenous cholecystitis, the sonographic Murphy sign was positive in only six (33%). Clinical examination showed a positive Murphy sign in eight patients (44%), diffuse abdominal pain in nine patients (50%), and no pain in one patient (6%). Other sonographic findings included pericholecystic fluid (10), thickening of the gallbladder wall (10), and a dilated gallbladder (five). Our experience suggests that the absence of the Murphy sign increases the possibility of gangrenous cholecystitis in patients with abdominal pain and sonographic findings of cholecystitis. |
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