What finding on ultrasound indicates cholecystitis?

• A. Gallstones only
• B. GB wall thickening >4mm
• C. Hepatomegaly
• D. Free fluid in the abdominal cavity

Answer: (B)

The indication of cholecystitis primarily hinges on the presence of gallbladder wall thickening. When the gallbladder wall measures greater than 4 mm, it is considered a significant indicator of inflammation, which is a hallmark of cholecystitis. This thickening occurs due to edema and inflammatory changes in the tissue surrounding the gallbladder, resulting from the inflammation that accompanies gallstone obstruction of the cystic duct.

While gallstones may be present in many patients with cholecystitis, the mere presence of gallstones alone is not definitive for diagnosing the condition, as they can exist without any inflammation. Hepatomegaly and free fluid in the abdominal cavity are not specific to cholecystitis; they can arise from numerous other conditions. Consequently, gallbladder wall thickening is a critical and specific sonographic finding that signals cholecystitis, differentiating it from other diagnoses that may also be encountered during abdominal ultrasound.