Serdar Ozdemir
Eurasian Journal of Critical Care - 2025;7(3):55-57
Diagnosing acute cholecystitis in patients with heart failure presents a significant clinical challenge due to overlapping symptoms, imaging findings, and inflammatory markers. The Tokyo Guidelines (TG18) provides a structured diagnostic framework based on clinical signs, imaging, and laboratory parameters. However, heart failure-particularly right-sided heart failure-factors such as hepatic congestion, peritoneal stretching, and systemic inflammation can mimic cholecystitis. Gallbladder wall thickening, a key imaging criterion, is often observed in heart failure due to venous congestion rather than true inflammation. Similarly, elevated inflammatory markers like C-reactive protein (CRP) and leukocytosis can result from the systemic inflammatory milieu of heart failure, not infection. This overlap risks both misdiagnosis and inappropriate treatment. This review highlights the diagnostic intersection, emphasizing the importance of a multidisciplinary approach, advanced imaging modalities, and dynamic monitoring. It also advocates for the development of integrated diagnostic tools tailored for this patient population. Accurate differentiation between true acute cholecystitis and heart failure-related changes is essential to avoid unnecessary interventions and optimize patient outcomes.
