Symptoms and Diagnosis of Contracted Gallbladder

Clinical Presentation

The American College of Radiology recommends that right upper quadrant and/or epigastric pain is the most characteristic symptom of a contracted gallbladder, which can be severe and steady in intensity 1
Pain may radiate to the upper back or right infrascapular area, according to the Clinical Gastroenterology and Hepatology guidelines 3
Episodes of pain typically last from 30 minutes to several hours or even up to a day, as reported by the Clinical Gastroenterology and Hepatology 3
Anorexia (loss of appetite) is common during symptomatic episodes, as noted by the American College of Radiology 1
Fever may be present, particularly if inflammation is significant, according to the American College of Radiology 1

The American College of Radiology states that the gallbladder may appear contracted or distended on imaging, depending on the underlying pathology 1, 4
Pericholecystic fluid is usually absent in chronic conditions but may be present in acute complications, as reported by the American College of Radiology 1, 5
Sonographic Murphy sign (focal tenderness over the gallbladder during ultrasound examination) may be present but has relatively low specificity, according to the American College of Radiology 1, 4
Ultrasound is the first-line imaging modality with 96% accuracy for detecting gallstones, as recommended by the American College of Radiology 1, 4
The diagnosis of chronic cholecystitis with a contracted gallbladder can be difficult on anatomic imaging alone, as noted by the American College of Radiology 1, 4

The American College of Radiology recommends ultrasound as the first-line imaging test for suspected gallbladder disease with right upper quadrant pain 1, 4
If ultrasound is inconclusive, hepatobiliary scintigraphy has higher sensitivity (97%) and specificity (90%) for detecting acute cholecystitis, as reported by the American College of Radiology 1, 4
CT or MRI may be used when other imaging is equivocal or to evaluate for complications, according to the American College of Radiology 5, 7