Abstract
Acute acalculous cholecystitis (AAC) can be defined as acute inflammatory disease of the gallbladder without evidence of gallstones. The first case was reported in 1844 by Duncan et al.; however, some cases may have been missed previously in view of the complexity of the diagnosis. Several risk factors have been identified, and cardiovascular disease (CVD), in view of its multiple mechanisms of action, seems to play a key role. Atypical clinical onset, paucity of symptoms, overlap with comorbidities, and lack of robust, controlled trials result often in under or misdiagnosed cases. Moreover, laboratory results may be negative or not specific in the late stage of the disease, when a surgical treatment cannot be longer helpful if complications arise. A rapid diagnosis is therefore essential to achieve a prompt treatment and to avoid further clinical deterioration. In this short review, we would present the current evidence regarding epidemiology, pathophysiology, and clinical presentation of the complex relation between AAC and CVD. Then, we fully emphasize the role of ultrasound to achieve an early diagnosis and an appropriate treatment in suspected cases, reducing mortality and complications rates.
Riassunto
La colecistite acuta alitiasica (AAC) può essere definita come una infiammazione acuta della colecisti in assenza di calcoli. Uno dei primi casi clinici riportati in letteratura risale al 1844 (Duncan et al.) ma verosimilmente alcuni di questi sono passati inosservati a causa della complessitá del percorso diagnostico. Numerosi fattori di rischio sono stati identificati e, tra questi, le malattie cardiovascolari, in considerazione di diversi meccanismi d’azione, sembrano assumere una posizione importante e giocare un ruolo chiave. Molti casi possono passare inosservati per varie ragioni che vanno dall’esordio clinico atipico, la povertá di sintomi, la sovrapposizione clinica e strumentale con altre comorbiditá, la carenza di trial controllati. Inoltre i test di laboratorio possono risultare negativi o non specifici anche negli stadi avanzati della malattia, quando la terapia chirurgica può non rivelarsi più utile in caso di complicanze. Una diagnosi rapida é dunque necessaria per instaurare un trattamento mirato e per evitare un ulteriore deterioramento clinico. In questa breve revisione vogliamo mettere in risalto le evidenze attuali che riguardano l’epidemiologia, la fisiopatologia e la presentazione clinica della complessa relazione esistente tra le malattie cardiovascolari e la colecistite acuta alitiasica. Il nostro intento é dunque quello di enfatizzare il ruolo dell’ultrasonografia nel raggiungimento, nei casi sospetti, di una diagnosi precoce e di un trattamento appropriato, al fine di ridurre il tasso di complicanze e la mortalitá.
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Abbreviations
- AAC:
-
Acute acalculous cholecystitis
- US:
-
Ultrasound scan
- CT:
-
Computed tomography
- ED:
-
Emergency Department
- EKG:
-
Electrocardiogram
- AMI:
-
Acute myocardial infarction
- CRP:
-
C-reactive protein
- ESR:
-
Erythrocyte sedimentation rate
- CVD:
-
Cardiovascular disease
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Tana, M., Tana, C., Cocco, G. et al. Acute acalculous cholecystitis and cardiovascular disease: a land of confusion. J Ultrasound 18, 317–320 (2015). https://doi.org/10.1007/s40477-015-0176-z
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DOI: https://doi.org/10.1007/s40477-015-0176-z