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Three Part Question

In [patients with right upper quadrant pain] does [US scanning] accurately detect [obstructive biliary disease]?

Clinical Scenario

A patient presents to the accident and emergency department with right upper quadrant pain. You are clinical suspicious of cholecystitis and wonder what diagnosic imaging would be best to confirm the diagnosis.

Search Strategy

Using MEDLINE and EMBASE databases the following search strategy was executed:
[(exp acute abdomen OR exp abdominal pain OR acute abdomen.mp OR abdominal pain.mp OR right upper quadrant pain.mp OR RUQ pain.mp) AND (exp Ultrasonography OR ultrasound.mp or ultrasonography.mp) AND ( exp cholecystitis OR exp gall stones OR exp cholestasis OR obstructive biliary disease.mp)] LIMIT to humans and English language

Search Outcome

159 articles were found, of which 4 were relevant. However, one failed to meet a good academic standard and therefore only 3 have been used for the final BET.

Relevant Paper(s)

Author, date and country	Patient group	Study type (level of evidence)	Outcomes	Key results	Study Weaknesses

Comment(s)

There is suggestion that USS may be better at detecting gall stones and chronic cholecystitis that acute cholecystitis

Clinical Bottom Line

USS may be a useful diagnostic test to help confirm the diagnosis of cholecystitis. However, further, good quality research is needed before any conclusion can be drawn.

References

1. McKay AJ, Duncan JG, Imrie CW, Joffe SN, Blumgart LH. A prospective study of the clinical value and accuracy of grey scale ultrasound in detecting gall stones. Br. J. Surg 1978;65(5):330-333.
2. Down RH, Arnold J, Goldin A, Watts JM, Benness G. Comparison of accuracy of Tc-pyridoxylidene glutamate scanning with oral cholecystography and ultrasonography in diagnosis f acute cholecystitis. Lancet 1979;2(8152):1094-7.
3. Matolo N.M, McGahan J.P, Stadalnik R.C. Comparison of Ultrasound, Computer Tomography and Radionuclide Imaging in the Diagnosis of Acute and Chronic Cholecystitis. American journal of sugery 1982;144(6):676-681.
4. Blackborne L.H, Earnhardt R.C, Sistrom C.L, Abbitt P, Scott-Jones R. The Sensitivity and Role of Ultrasound in the Evaluation of Biliary Obstruction. American Surgeon 1994;60(9):683-689.