Acute Cholecystitis in AIDS Patients: Correlation of Tc-99m Hepatobiliary Scintigraphy with Histopathologic Laboratory Findings and CD4 Counts
| Autor: | Armond G. Cacciarelli, Walid S. Omar, Hani H. Abujudeh, Sleiman Naddaf, Mohamed Aziz, H. El-Zeftawy, Hussein M. Abdel-Dayem, John Gillooley, S. Atay, Mithilesh Kumar |
|---|---|
| Rok vydání: | 1998 |
| Předmět: |
medicine.medical_specialty
Opportunistic infection Scintigraphy Sensitivity and Specificity Gastroenterology Cholelithiasis Internal medicine Cholecystitis medicine Humans Cholecystectomy Radiology Nuclear Medicine and imaging Radionuclide Imaging Retrospective Studies Ascending cholangitis Acquired Immunodeficiency Syndrome AIDS-Related Opportunistic Infections medicine.diagnostic_test business.industry Gallbladder Mortality rate Technetium Tc 99m Lidofenin General Medicine medicine.disease CD4 Lymphocyte Count medicine.anatomical_structure Acute Disease Histopathology Complication business |
| Zdroj: | Clinical Nuclear Medicine. 23:226-228 |
| ISSN: | 0363-9762 |
| DOI: | 10.1097/00003072-199804000-00007 |
| Popis: | AIDS patients are susceptible to opportunistic gastrointestinal infections including ascending cholangitis and cholecystitis, especially if CD4 count is200. Incidence of acalculous cholecystitis has not been reported previously.We aim to evaluate the incidence of acalculous cholecystitis in AIDS patients and to identify causative organisms and mortality rate following cholecystectomy.We reviewed the files of 46 patients in order to meet the objectives of this study.CD4 counts were200 in 31 patients and200 in 15 patients. HIDA imaging was performed in 31 patients; in 8, the CD4 count was200 and all had calculous cholecystitis. The gallbladder was visualized in 3 patients for a sensitivity of 63% and no organisms were found in the gallbladder specimens. In 23 patients, the CD4 count was200; the gallbladder was visualized in 5 patients for a HIDA sensitivity of 78%; 16 (52%) had acalculous cholecystitis; and 15 had calculous cholecystitis. In acalculous cholecystitis, Cryptosporidium was found in six cases, cytomegalovirus (CMV) in six cases, and fungus, yeast, tuberculosis, and mycobacterium avium intracellular each in one case. The thirty day mortality rate was 18%; 5 of 28 who underwent open cholecystectomy died within 30 days, 4 of them with a CD4 count200. There was no mortality in the 26 patients who underwent laparoscopic cholecystectomy.(1) Because of the high incidence of 52% of acalculous cholecystitis in AIDS patients with a CD4 count200, we recommend using intravenous cholecystokinin if the gallbladder is visualized on hepatobiliary scintigraphy in order to determine gallbladder ejection fraction and exclude acalculous cholecystitis. (2) Laparoscopic rather than open cholecystectomy should be the surgical procedure of choice in AIDS patients especially if the CD4 count is200. |
| Databáze: | OpenAIRE |
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