Is it acalculous cholecystitis or reactive/viral pericholecystits in acute hepatitis?

Dear Editor, we read with great interest the case report written by Dr Souza LJ et al. titled “Acute acalculous cholecystitis in a teenager with hepatitis A virus infection: a case report” published in the February 2009 issue of the Brazilian Journal of Infectious Diseases. The authors describe a case of acalculous cholecystitis (AC) in a 16-year-old male during an episode of hepatitis A virus infection. Diagnosis of AC had been made on the basis of clinical symptoms and signs supported with sonographic scan evidence. The authors have presented four ultrasonography (USG) scan images (Figures 1-4) supporting a diagnosis of AC. It has been mentioned that the gall bladder wall was thickened and surrounded by echogenic content. After analyzing the USG images carefully, we strongly feel that the given images may not support a diagnosis of AC. The size of the gall bladder (GB) as shown in Figure 1 appears rather small. Besides, there has been no mention about any abnormality of the GB contents. Mere presence of gall bladder wall thickening and pericholecystic fl uid is not enough for a diagnosis of AC as such fi ndings are not uncommon in acute hepatitis without AC.