AMONG the common abdominal diseases, cholecystitis, acute and chronic, has the reputation as the easiest to recognize on the basis of history and physical examination. Prior to objective studies, the clinician is likely to feel more confident about his working diagnosis of gallbladder disease than that of such problems as gastric or duodenal ulcer, cecal carcinoma, small bowel inflammatory disease, and others. Furthermore, it can be agreed that cholecystography is one of the most reliable of the radiologic diagnostic techniques used for investigation of abdominal complaints.
Nevertheless, it is not rare for the clinician to find that the cholecystogram is normal in the patient who, he is certain, has the historical and physical findings that indicate gallbladder disease.
When this happens, can the clinician choose his bedside opinion over the radiologist's? Can he decide on cholecystectomy, perhaps assuming cholesterosis or biliary mud or simply some more common gallbladder
Palmer ED. Gallbladder Symptoms and the Roentgenographically Normal Gallbladder. JAMA. 1974;229(13):1803. doi:10.1001/jama.1974.03230510071036