Acute cholecystitis: what to expect from ultrasound

Congress:

ECR 2018

Poster Number:

C-3083

Type:

Educational Exhibit

Keywords:

Diagnostic procedure, Education, Ultrasound, Emergency, Abdomen, Acute, Inflammation, Calcifications / Calculi

Authors:

P. M. G. Alves¹, R. Monteiro², A. R. Ventosa¹, M. D. Claudino³; ¹Faro/PT, ²Portimao/PT, ³Tavira/PT

DOI:

10.1594/ecr2018/C-3083

DOI-Link:

https://dx.doi.org/10.1594/ecr2018/C-3083

Fig. 1: Ultrasound image showing GB wall thickening in a pacient with heart failure.

Fig. 6: Ultrasound image showing gangrenous cholecystitis. Asymmetric wall thickness.

Fig. 4: Ultrasound image showing acute calculous cholecystitis with diffuse gallbladder...

Fig. 8: Ultrasound images showing GB perforation. Red arrow - abscess adjacent to liver...

Fig. 9: Ultrasound image showing ecogenic content within the lumen of the GB and CT...

Learning objectives

- Understand the differential diagnosis of gallbladder wall thickening - Review of sonographic features associated with acute cholecystitis - Describe pathophysiology and different patterns of cholecystitis - Recognize the findings in acute cholecystitis complications

Background

Sonography is the first imaging technique used when evaluating patients with right upper quadrant pain due to its high sensitivity for detecting of gallbladder stones.There are other benefits to using sonography such as its real-time character, being widely available, non-invasive and inexpensive. Biliary colic and acute cholecystitis (AC) represent a principal cause of morbidity worldwide. Quick diagnosis is essential to prevent complications. Gallbladder (GB) wall thickening is a common yet nonspecific finding that can occur in a wide range of GB diseases and extracholecystic conditions....

Findings and procedure details

1. Gallbladder wall thickening The normal gallbladder wall appears as a pencil-thin echogenic line on sonography. A thickened gallbladder wall measures more than 3 mm, and typically has a layered appearance at sonography (1). Differential diagnosis of diffuse gallbladder wall thickening: Cholecystitis (acute; chronic; acalculous; xanthogranulomatous) Direct inflammatory spread from adjacent structures (pancreatitis; hepatitis; pyelonephritis) Systemic disease (Heart failure; Kidney failure; Chronic hepatic disease; Sepsis) Carcinoma Hyperplastic changes (adenomyomatosis) In some cases,pseudothickening is mentioned because the thickness of the GB wall depends on the degree...

Conclusion

It is important to know the most common differential diagnosis of GB wall thickness in order to avoid misdiagnosis or unnecessary surgical interventions. The cause of gallbladder wall thickening can be determined in most cases by correlation of the clinical presentation and associated imaging findings. Ultrasound as the initial imaging modality is often sufficient for correct diagnosis. The morbidity and mortality rise with complications of AC, which makes so important to know the features that may indicate a complication on ultrasound.

Personal information

P. Alves, R. Monteiro, A.R. Ventosa, M.D. Claudino; Centro Hospitalar do Algarve - Radiology Department, Portugal

References

(1) Rumack CM, Wilson SR, Charboneau JW. Diagnostic Ultrasound, 2nd ed. St.Louis: Mosby, 1998:175-200 (2) Gabriel J. Runner, Michael T. Corwin, Bettina Siewert, Ronald L. Eisenberg. Gallbladder Wall Thickening. American Journal of Roentgenology 2014;202:W1-W12 (3) Mellnick VM, Menias CO, Sandrasegaran K et-al. Polypoid lesions of the gallbladder: disease spectrum with pathologic correlation. Radiographics. 2015;35 (2): 387-99. (4) Gore RM, Yaghmai V, Newmark GM, Berlin JW, Miller FH. Imaging of benign and malignant disease of the gallbladder. Radiol Clin N Am 2002; 40:1307-1323 (5) Kiewiet J.,...