A 35-year-old woman presents with right upper quadrant pain and fever. Ultrasound shows gallbladder wall thickness of 5 mm, pericholecystic fluid, and a sonographic Murphy sign. Which single finding is considered the MOST sensitive sonographic feature of acute cholecystitis?
- A A positive sonographic Murphy sign ✓
- B Gallbladder wall thickening greater than 3 mm
- C Pericholecystic fluid collection
- D Gallbladder distension greater than 10 cm in length
Correct answer: A. A positive sonographic Murphy sign
Explanation
The sonographic Murphy sign, maximal tenderness over the sonographically localised gallbladder, is the most sensitive individual feature of acute calculous cholecystitis, approaching 90% sensitivity. Wall thickening above 3 mm, pericholecystic fluid and gallbladder distension are all supportive but each is less sensitive, and wall thickening alone lacks specificity since it also occurs in hypoalbuminaemia, hepatitis and heart failure. The combination of findings, especially with an impacted stone at the neck, secures the diagnosis.
Reference: Grainger and Allison's Diagnostic Radiology, 7th ed.
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