Gallbladder carcinoma manifesting as acute cholecystitis: Clinical and computed tomographic features

Background: Gallbladder carcinoma is uncommon and may manifest as acute cholecystitis. An accurate diagnosis is helpful for operative planning and this study attempted to explore the distinctive clinical and computed tomographic (CT) features for differentiating acute cholecystitis alone from that with contemporaneous gallbladder carcinoma. Methods: This 20-year, retrospective study evaluated the CT features of 26 patients with surgically proven gallbladder carcinoma with clinical presentations of acute cholecystitis (carcinoma group). Thirty elderly patients with surgically proven simple acute cholecystitis were enrolled as age-matched controls (cholecystitis group). The clinical, laboratory, and CT findings were compared between the 2 groups. Results: The carcinoma and cholecystitis groups showed no significant differences with respect to clinical symptoms (abdominal pain, fever, and jaundice), serum total bilirubin level, leukocyte count, percentage of segmented leukocytes, presence of gallstones, and CT features of pericholecystic stranding/fluid and focally increased enhancement of adjacent liver. Fifteen of the 26 (57.6%) patients in the carcinoma group exhibited diffuse gallbladder wall thickening on CT and the other 11 exhibited focal thickening or intraluminal masses. Beside female predominance, the patients in the carcinoma group had significantly higher serum aspartate/alanine aminotransferase and alkaline phosphatase levels, a thicker gallbladder wall, smaller volume, lower frequency of triple-layer gallbladder wall enhancement pattern, and a higher frequency of enlarged regional lymph nodes than those in the cholecystitis group. Conclusion: For elderly patients, especially women, presenting with acute cholecystitis and abnormal liver function, CT demonstration of focal gallbladder wall thickening, intraluminal masses, small gallbladder with diffuse wall thickening, and enlarged regional lymph nodes are suggestive of concurrent gallbladder carcinoma. Triple-layer gallbladder wall enhancement is suggestive of simple acute cholecystitis.