To the Editor.—
I take strong exception to the views expressed by Ronald Tompkins, MD, in response to a question regarding selection of diagnostic modality for diagnosis of acute cholecystitis (1981;246:2868). I believe he has provided an ambiguous answer to the question and has also denigrated the facts by labeling them nonscientific and nonmedical.The shortcoming of ultrasound in proper delineation of cystic duct area is known to all who are involved in sonography. The problem is further complicated by the "fibrous spiral valves" in the region of the neck of the gallbladder that can cause acoustic shadowing. Furthermore, if there are small stones lying incidentally in the region of Hartmann's pouch, one can never be sure whether these are the real cause of acute symptoms.1The sonographic criteria mentioned by Dr Tompkins are "great," if present. Raghavendra et al2 have shown that only 70% of patients with
Asgher J. Diagnosis of Acute Cholecystitis. JAMA. 1982;247(20):2781–2782. doi:10.1001/jama.1982.03320450019021
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