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Letters Reply to “Association Between Any Histologic Features and Wall Striations” We thank Yildiz et al. [1] for their comments and agree with them regarding the risk factors of age, diabetes, and renal and cardiac impairment. These risks have been extensively discussed in the clinical literature as was noted in the first paragraph of the Discussion section of our article [2]. The purposes of our article were first to determine whether gallbladder wall striations in patients with sonographic findings suspicious for acute cholecystitis are associated with gangrenous changes and certain histologic features and second to determine whether the WBC count or other sonographic findings are associated with gangrenous cholecystitis. We agree that gangrenous changes can develop in patients with acalculous cholecystitis and that pericholecystic abscess and
gallbladder wall perforation are also findings of gangrenous cholecystitis. We wrote such an article several years ago [3]. Please refer to the Other Sonographic and Clinical Findings and Pathology Diagnoses heading under the Results section in that article. We state that the fluid collections that were visualized in our study were simple and crescentshaped and not complex. Additionally, in the Discussion section, we state that although all of our pericholecystic fluid collections were simple, anechoic, and crescent-shaped, complex pericholecystic fluid collections are indicative of perforation and are frequently associated with gangrenous changes [3]. Finally, regarding the comment that we did not state the association between coagulative necrosis and gangrenous cholecystitis, in the Materials and Methods section under the heading of Sonographic and Clinical Findings, we defined gangrenous chole-
cystitis as transmural necrosis of the gross specimen [2]. Sharlene A. Teefey Nirvikar Dahiya William D. Middleton Mallinckrodt Institute of Radiology, St. Louis, MO DOI:10.2214/AJR.14.13039 WEB—This is a web exclusive article.
References 1. Yildiz S, Menzilcioglu MS, Duymus M. Association between any histologic features and wall striations. (letter) AJR 2014; 203:[web]W550 2. Teefey SA, Dahiya N, Middleton WD, et al. Acute cholecystitis: do sonographic findings and WBC count predict gangrenous changes? AJR 2013; 200:363–369 3. Teefey SA, Baron RL, Radke HM, Bigler SA. Gangrenous cholecystitis: new observations on sonography. J Ultrasound Med 1991; 10:603–606
AJR 2014; 203:W551 0361–803X/14/2035–W551 © American Roentgen Ray Society
AJR:203, November 2014 W551
Letters Reply to “Association Between Any Histologic Features and Wall Striations” We thank Yildiz et al. [1] for their comments and agree with them regarding the risk factors of age, diabetes, and renal and cardiac impairment. These risks have been extensively discussed in the clinical literature as was noted in the first paragraph of the Discussion section of our article [2]. The purposes of our article were first to determine whether gallbladder wall striations in patients with sonographic findings suspicious for acute cholecystitis are associated with gangrenous changes and certain histologic features and second to determine whether the WBC count or other sonographic findings are associated with gangrenous cholecystitis. We agree that gangrenous changes can develop in patients with acalculous cholecystitis and that pericholecystic abscess and
gallbladder wall perforation are also findings of gangrenous cholecystitis. We wrote such an article several years ago [3]. Please refer to the Other Sonographic and Clinical Findings and Pathology Diagnoses heading under the Results section in that article. We state that the fluid collections that were visualized in our study were simple and crescentshaped and not complex. Additionally, in the Discussion section, we state that although all of our pericholecystic fluid collections were simple, anechoic, and crescent-shaped, complex pericholecystic fluid collections are indicative of perforation and are frequently associated with gangrenous changes [3]. Finally, regarding the comment that we did not state the association between coagulative necrosis and gangrenous cholecystitis, in the Materials and Methods section under the heading of Sonographic and Clinical Findings, we defined gangrenous chole-
cystitis as transmural necrosis of the gross specimen [2]. Sharlene A. Teefey Nirvikar Dahiya William D. Middleton Mallinckrodt Institute of Radiology, St. Louis, MO DOI:10.2214/AJR.14.13039 WEB—This is a web exclusive article.
References 1. Yildiz S, Menzilcioglu MS, Duymus M. Association between any histologic features and wall striations. (letter) AJR 2014; 203:[web]W550 2. Teefey SA, Dahiya N, Middleton WD, et al. Acute cholecystitis: do sonographic findings and WBC count predict gangrenous changes? AJR 2013; 200:363–369 3. Teefey SA, Baron RL, Radke HM, Bigler SA. Gangrenous cholecystitis: new observations on sonography. J Ultrasound Med 1991; 10:603–606
AJR 2014; 203:W551 0361–803X/14/2035–W551 © American Roentgen Ray Society
AJR:203, November 2014 W551
