Gall bladder disease has long been thought to be capable of inducing various types of anginal and nonanginal chest pain. Compared to other GI (gastroesophageal) causes of chest pain, however, acute and chronic cholecystitis is relatively uncommon. The relationship between cholecystitis and coronary pain remains obscure, since some cases of acute MI may present in a manner clinically indistinguishable from gall bladder colic or may coexist.

Sonography of the gall bladder used to be advocated as the best first imaging study since more than 80%-90% of inflammatory disease of the organ is associated with stones. The presence of stones, however, is common in the general population, ranging from 3-7% in the young to 28% in the elderly. Moreover, acalculous cholecystitis is becoming increasingly recognized, so that the diagnosis of an acute gall bladder must be confirmed clinically by significant localizing abdominal findings. The best confirmatory test remains the RADIONUCLIDE HEPATOBILIARY scan, preferably performed as close to the symptomatic episode as possible, (optimally within 1-2 days of an attack.) Failure of the gall bladder to visualize (with due attention to proper patient preparation) with one of the imidodiacetic acid analogues (HIDA, etc.) within 2-4 hours indicates a 99% pretest probability of acute cholecystitis. Delayed visualization beyond 45-60 minutes almost always indicates chronic cholecystitis.