A case of gallbladder torsion in which contrast-enhanced ultrasonography was useful

Abstract

Gallbladder torsion is an acute abdominal condition that causes obstruction of blood flow to the gallbladder and requires early surgical intervention. However, gallbladder torsion is sometimes difficult to distinguish from acute cholecystitis because the clinical symptoms and ultrasonographic findings are similar. We report a case in which contrast-enhanced ultrasonography (CEUS) was useful in the diagnosis of gallbladder torsion. The patient was a woman in her 80s who was referred to our hospital with a chief complaint of worsening pericardial pain. Contrast-enhanced computed tomography revealed acute cholecystitis, and ultrasonography showed an enlarged gallbladder and a hyperechoic lesion in the neck, suggesting gallbladder torsion. CEUS was Sonazoid performed to confirm the diagnosis, at which no contrast medium was seen flowing into the gallbladder wall or the cervical hyperechoic lesion. The operative findings also showed torsion in the neck of the gallbladder, and a final diagnosis of gallbladder torsion was made. CEUS can easily confirm the presence or absence of blood flow, and is thought to be capable of diagnosing gallbladder torsion. Furthermore, Sonazoid, an ultrasound contrast agent, can be used in patients with impaired renal function, and the examination can be performed with conventional ultrasound equipment at the bedside, such as in the emergency room. CEUS is a very useful method for quickly and easily differentiating acute cholecystitis and gallbladder torsion.