Diagnostic criteria for acute cholecystitis

The Tokyo Guidelines (TG13/TG18) for the management of acute cholangitis and cholecystitis proposed the following as diagnostic criteria for acute cholecystitis:

A. Local signs of inflammation, etc.:
(1) Murphy's sign, (2) RUQ mass/pain/tenderness

B. Systemic signs of inflammation, etc.:
(1) Fever, (2) elevated CRP, (3) elevated WBC count

C. Imaging findings: imaging findings characteristic of acute cholecystitis

Suspected diagnosis:

• one item in A+ one item in B

Definite diagnosis:

• one item in A+ one item in B + C

Note: acute hepatitis, other acute abdominal disease, and chronic cholecystitis should be excluded

Reference:

1. Yokoe M, et al.Tokyo Guidelines 2018: diagnostic criteria and severity grading of acute cholecystitis (with videos). J Hepatobiliary Pancreat Sci. 2018 Jan;25(1):41-54. doi: 10.1002/jhbp.515. Epub 2018 Jan 9. PMID: 29032636.