diagnostic criteria for acute cholecystitis

Last edited 02/2022 and last reviewed 02/2022

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: