Tensile gallbladder fundus sign

摘要

Absence of flattening of gall bladder by the peritoneal surface of overlying anterior abdominal wall on at least one axial CT section is known as the 'tensile gall bladder fundus sign' (Fig. 1, 2) [1]. Figure 3 shows a normal gallbladder fundus indented and flattened by the anterior abdominal wall . This sign commonly occurs due to the increased gall bladder pressure associated with gall bladder distension commonly seen in acute cholecystitis patients [1]. Figure 4 shows taut distension of a trumpeter's cheeks which is metaphorically similar to the tensile gall bladder. CT features of uncomplicated acute cholecystitis include combination of gall bladder over-distension, mural thickening, mural enhancement, peri-cholecystic fat stranding, pericholecystic fluid, and reactive liver parenchymal enhancement [2]. 'Tensile gall bladder fundus sign' was found to be helpful in the early diagnosis of acute cholecystitis, even when inflammatory changes were not present on CT, with a sensitivity of 74% and specificity of 96 % [1]. 'Tensile gall bladder fundus sign' showed better diagnostic performance than diagnosis of gall bladder distention by size criteria in diagnosis of acute cholecystitis [1, 3]. 'Tensile gall bladder fundus sign' could be extrapolated to all cross sectional imaging modalities to identify early acute cholecystitis even without other findings.