A 50-year-old woman comes to the emergency department with severe upper abdominal pain. The pain started suddenly and is sharp and colicky. She has also vomited several times throughout the day, including once while in the emergency department. The patient describes several prior episodes of similar abdominal pain that resolved spontaneously without treatment. Her other medical problems include complicated appendicitis when she was 22 years old. Her temperature is 37.8 C (100 F) and pulse is 112/min. Abdominal examination shows cessation of inspiration with deep palpation of the right upper quadrant. Laboratory assessment shows a serum bilirubin of 0.8 mg/dL and a serum alkaline phosphatase of 100 U/L. Initial imaging studies are equivocal. Which of the following diagnostic test results would be most specific for acute cholecystitis?
A. Distended duodenum on upper gastrointestinal series
B.Echogenic structures inside the gallbladder on abdominal ultrasound
C. Failed gallbladder visualization on radionuclide biliary scan
D. Increased serum aspartate and alanine aminotransferase levels
E.Opacities in the right subcostal area on abdominal x-ray