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      Acalculous Cholecystitis: The Unexpected Mask of De Novo Heart Failure

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          ABSTRACT

          Acute acalculous cholecystitis refers to inflammation of the gallbladder without the presence of gallstones or obstruction of the cystic duct. Heart failure is recognized for causing congestive hepatopathy and can lead to gallbladder swelling, often challenging to distinguish from acalculous cholecystitis. Here, we present a case of a patient whose symptoms initially resembled acalculous cholecystitis but were instead caused by acute severe heart failure and cardiogenic shock. Maintaining a broad differential diagnosis, including decompensated heart failure, is essential when evaluating cases resembling acalculous cholecystitis.

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          Acute Cholecystitis: A Review

          Jared R. Gallaher, Anthony T Charles (2022)
          Article 0 comments Cited 95 times – based on 0 reviews     Review now
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            Acute acalculous cholecystitis: a review.

            Jason Huffman, Steven Schenker (2010)
            Although recognized for more than 150 years, acute acalculous cholecystitis (AAC) remains an elusive diagnosis. This is likely because of the complex clinical setting in which this entity develops, the lack of large prospective controlled trials that evaluate various diagnostic modalities, and thus dependence on a small data base for clinical decision making. AAC most often occurs in critically ill patients, especially related to trauma, surgery, shock, burns, sepsis, total parenteral nutrition, and/or prolonged fasting. Clinically, AAC is difficult to diagnose because the findings of right upper-quadrant pain, fever, leukocytosis, and abnormal liver tests are not specific. AAC is associated with a high mortality, but early diagnosis and intervention can change this. Early diagnosis is the crux of debate surrounding AAC, and it usually rests with imaging modalities. There are no specific criteria to diagnose AAC. Therefore, this review discusses the imaging methods most likely to arrive at an early and accurate diagnosis despite the complexities of the radiologic modalities. A pragmatic approach is vital. A timely diagnosis will depend on a high index of suspicion in the appropriate patient, and the combined results of clinical findings (admittedly nonspecific), plus properly interpreted imaging. Sonogram (often sequential) and hepatic iminodiacetic acid scans are the most reliable modalities for diagnosis. It is generally agreed that cholecystectomy is the definitive therapy for AAC. However, at times a diagnostic/therapeutic drainage via interventional radiology/surgery may be necessary and life-saving, and may be the only treatment needed. Copyright (c) 2010 AGA Institute. Published by Elsevier Inc. All rights reserved.
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              New diagnostic criteria and severity assessment of acute cholecystitis in revised Tokyo guidelines

              Masamichi Yokoe, Tadahiro Takada, Steven M. Strasberg … (2012)
              Background The Tokyo Guidelines for the management of acute cholangitis and cholecystitis (TG07) were published in 2007 as the world’s first guidelines for acute cholangitis and cholecystitis. The diagnostic criteria and severity assessment of acute cholecystitis have since been widely used all over the world. A validation study of TG07 has shown that the diagnostic criteria for acute cholecystitis are highly reliable but that the definition of definite diagnosis is ambiguous. In addition, considerable new evidence referring to acute cholecystitis as well as evaluations of TG07 have been published. Consequently, we organized the Tokyo Guidelines Revision Committee to evaluate TG07, recognize new evidence, and conduct a multi-center analysis to revise the guidelines (TG13). Methods and materials We retrospectively analyzed 451 patients with acute cholecystitis from multiple tertiary care centers in Japan. All 451 patients were first evaluated using the criteria in TG07. The “gold standard” for acute cholecystitis in this study was a diagnosis by pathology. The validity of TG07 diagnostic criteria was investigated by comparing clinical with pathological diagnosis. Results Of 451 patients evaluated, a total of 227 patients were given a diagnosis of acute cholecystitis by pathological examination (prevalence 50.3 %). TG07 criteria provided a definite diagnosis of acute cholecystitis in 224 patients. The sensitivity of TG07 diagnostic criteria for acute cholecystitis was 92.1 %, and the specificity was 93.3 %. Based on the preliminary results, new diagnostic criteria for acute cholecystitis were proposed. Using the new criteria, the sensitivity of definite diagnosis was 91.2 %, and the specificity was 96.9 %. The accuracy rate was improved from 92.7 to 94.0 %. In regard to severity grading among 227 patients, 111 patients were classified as Mild (Grade I), 104 as Moderate (Grade II), and 12 as Severe (Grade III). Conclusion The proposed new diagnostic criteria achieved better performance than the diagnostic criteria in TG07. Therefore, the proposed criteria have been adopted as new diagnostic criteria for acute cholecystitis and are referred to as the 2013 Tokyo Guidelines (TG13). Regarding severity assessment, no new evidence was found to suggest that the criteria in TG07 needed major adjustment. As a result, TG07 severity assessment criteria have been adopted in TG13 with minor changes.
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                Author and article information

                Contributors
                Mhd Baraa Habib:
                ORCID: https://orcid.org/0000-0003-4585-2883
                mhabib2@hamad.qa
                Journal
                Journal ID (nlm-ta): Clin Case Rep
                Journal ID (iso-abbrev): Clin Case Rep
                Journal ID (doi): 10.1002/(ISSN)2050-0904
                Journal ID (publisher-id): CCR3
                Title: Clinical Case Reports
                Publisher: John Wiley and Sons Inc. (Hoboken )
                ISSN (Electronic): 2050-0904
                Publication date (Electronic): 19 March 2025
                Publication date Collection: March 2025
                Volume: 13
                Issue: 3 ( doiID: 10.1002/ccr3.v13.3 )
                Electronic Location Identifier: e70324
                Affiliations
                [ 1 ] Department of Cardiology Hamad Medical Corporation Doha Qatar
                [ 2 ] Department of Internal Medicine University of Toledo Medical Center Toledo Ohio USA
                [ 3 ] Department of Internal Medicine Hamad Medical Corporation Doha Qatar
                [ 4 ] Department of Internal Medicine MedStar Health Baltimore Maryland USA
                [ 5 ] Department of Gastroenterology University of Toledo Medical Center Toledo Ohio USA
                Author notes
                [*] [* ] Correspondence:

                Mhd Baraa Habib ( mhabib2@ 123456hamad.qa )

                Author information
                https://orcid.org/0000-0003-4585-2883
                https://orcid.org/0000-0001-6751-619X
                Article
                Publisher ID: CCR370324 Other ID: CCR3-2024-11-3453.R1
                DOI: 10.1002/ccr3.70324
                PMC ID: 11923240
                PubMed ID: 40114992
                SO-VID: 9a57dd66-4786-49bf-8827-c1856e4602ec
                Copyright © © 2025 The Author(s). Clinical Case Reports published by John Wiley & Sons Ltd.
                License:

                This is an open access article under the terms of the http://creativecommons.org/licenses/by/4.0/ License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.

                History
                Date revision received : 29 January 2025
                Date received : 11 November 2024
                Date accepted : 25 February 2025
                Page count
                Figures: 3, Tables: 2, Pages: 5, Words: 3000
                Categories
                Subject: Case Report
                Subject: Case Report
                Custom metadata
                source-schema-version-number 2.0
                cover-date March 2025
                details-of-publishers-convertor Converter:WILEY_ML3GV2_TO_JATSPMC version:6.5.4 mode:remove_FC converted:20.03.2025

                Keywords: acalculous cholecystitis,cardiogenic shock,case report,heart failure
                Data availability:
                Keywords: acalculous cholecystitis, cardiogenic shock, case report, heart failure

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