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American Journal of Roentgenology, Vol 152, Issue 2, 289-290
Copyright © 1989 by American Roentgen Ray Society

Articles

The sonographic diagnosis of acute gangrenous cholecystitis: importance of the Murphy sign

JF Simeone, JA Brink, PR Mueller, C Compton, PF Hahn, S Saini, SG Silverman, G Tung, and JT Ferrucci

Department of Radiology, Massachusetts General Hospital, Boston 02114.

The sonographic Murphy sign is defined as the presence of maximal tenderness elicited by direct pressure of the transducer over a sonographically localized gallbladder. The reported prevalence of this sign is more than 95% in patients with acute cholecystitis. In this series of 18 patients with pathologically proved gangrenous cholecystitis, the sonographic Murphy sign was positive in only six (33%). Clinical examination showed a positive Murphy sign in eight patients (44%), diffuse abdominal pain in nine patients (50%), and no pain in one patient (6%). Other sonographic findings included pericholecystic fluid (10), thickening of the gallbladder wall (10), and a dilated gallbladder (five). Our experience suggests that the absence of the Murphy sign increases the possibility of gangrenous cholecystitis in patients with abdominal pain and sonographic findings of cholecystitis.
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