Acute cholecystitis diagnostic criteria
Acute cholecystitis diagnosis is made using the Tokyo Guidelines 2018 (TG18) criteria based on local signs of inflammation, systemic signs of inflammation, and imaging findings. [1]
Local signs of inflammation (Category A)
At least one item in Category A supports suspected acute cholecystitis. [1]
- Murphy’s sign. [1]
- RUQ mass/pain/tenderness. [1]
Systemic signs of inflammation (Category B)
At least one item in Category B supports suspected acute cholecystitis. [1]
- Fever. [1]
- Elevated C-reactive protein (CRP). [1]
- Elevated white blood cell (WBC) count. [1]
Imaging findings (Category C)
Imaging findings must be characteristic of acute cholecystitis to establish a definite diagnosis. [1]
- Gallbladder wall thickening (for example, ≥4 mm). [2]
- Gallbladder enlargement (for example, long axis ≥8 cm and short axis ≥4 cm). [2]
- Gallstones or retained debris. [2]
- Pericholecystic fluid accumulation. [2]
- Linear shadows in the fatty tissue around the gallbladder. [2]
Suspected vs definite diagnosis
- Suspected acute cholecystitis: one item in Category A plus one item in Category B. [1]
- Definite acute cholecystitis: one item in Category A plus one item in Category B plus imaging findings in Category C. [1]
Conditions to exclude
Acute hepatitis, other acute abdominal diseases, and chronic cholecystitis should be excluded. [1]