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
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Diagnostic Ultrasound,
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St.Louis: Mosby,
1998:175-200
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Runner,
Michael T.
Corwin,
Bettina Siewert,
Ronald L.
Eisenberg.
Gallbladder Wall Thickening.
American Journal of Roentgenology 2014;202:W1-W12
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Menias CO,
Sandrasegaran K et-al.
Polypoid lesions of the gallbladder: disease spectrum with pathologic correlation.
Radiographics.
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(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.,...