A patient presented with Right upper quadrant pain with dyspepsia. USG showed Edematous Gallbladder wall. What will be the most sensitive investigation to confirm the suspected diagnosis here?
**Core Concept**
The patient's presentation of right upper quadrant pain with dyspepsia and an edematous gallbladder wall on ultrasound is suggestive of acute cholecystitis. This condition is characterized by inflammation of the gallbladder, often due to gallstones obstructing the cystic duct.
**Why the Correct Answer is Right**
The most sensitive investigation for confirming acute cholecystitis is the **Hepatobiliary Iminodiacetic Acid (HIDA) scan**. This nuclear medicine test involves injecting a radioactive tracer that is taken up by the liver and excreted into the bile. If the gallbladder is inflamed, the tracer will not be able to enter the gallbladder, indicating a blockage in the cystic duct. This is a sensitive indicator of acute cholecystitis, especially in cases where ultrasound is inconclusive.
**Why Each Wrong Option is Incorrect**
**Option A:** CT scan is less sensitive than HIDA scan for detecting acute cholecystitis, especially in early stages.
**Option B:** MRI is not typically used as a first-line investigation for acute cholecystitis due to its higher cost and lower availability compared to ultrasound and HIDA scan.
**Option C:** Ultrasound is a useful initial investigation, but it may not always be able to confirm the diagnosis, especially in cases of small gallstones or in patients with a high body mass index (BMI).
**Clinical Pearl / High-Yield Fact**
In cases of suspected acute cholecystitis, a HIDA scan should be considered if ultrasound findings are inconclusive or if there is a high clinical suspicion of the condition.
**Correct Answer:** C. HIDA scan