Ultrasound in Diagnosis of Acute Cholecystitis

To the Editor.— In Dr Hermann's article on acute cholecystitis (234:1261, 1975) there is an important oversight, namely, the failure to note the role of ultrasound in the workup of patients suspected of having acute cholecystitis. When a pathologic gallbladder condition has not been documented previously, the ultrasonic evaluation of the gallbladder should be the first test performed, since the presence or absence of stones can be determined with greater than 90% accuracy. 1-3 If stones are identified by ultrasound, the diagnosis is made. Conversely, if the gallbladder is seen but stones are not identified ultrasonically, the diagnosis of acute cholecystitis must be questioned. Hydrops of the gallbladder can also be readily identified. In centers where ultrasound is available, assessment of the gallbladder can be nearly instantaneous. No patient preparation is necessary, and neither oral nor intravenous contrast agents are used. The study is quick, painless, noninvasive, and accurate. What