February 7, 2009

Thickened Gallbladder Wall

Fig. 1: Transverse ultrasound image of the gallbladder in a 79-year-old afebrile woman with RUQ pain. There is diffuse gallbladder wall thickening (6 mm) and a hyperechoic material (arrow) in the gallbladder lumen. The gallbladder is distended.
Fig. 2: Longitudinal US image shows acoustic shadowing casted from hyperechoic material, representing a gallstone.

Differential Diagnosis of Thickened Gallbladder Wall

  1. Gallbladder disease - cholecystitis (acute or chronic)
  2. Liver disease - hepatitis, cirrhosis
  3. Diffuse disease - hypoalbuminemia, heart failure, renal failure
Our case was a surgically proven acute calculous cholecystitis.

Reference:
Chapman S and Nakielny R. Aid to radiological differential diagnosis. 4th ed.

4 comments:

ZyberNav said...

Thank you krub..

Is the "Pericholecystic fluid" more specific krub?

Rathachai Kaewlai, M.D. said...

If you mean specific signs for acute cholecystitis on ultrasound: gallstone + impacted stone at the gallbladder neck + sonographic Murphy's sign. All three "together" are very specific for acute cholecystitis. Pericholecystic fluid can be seen in non-gallbladder pathologies.

emergencyradiology said...

Vary good to memory.
And..What about non fasting patient. How often thickened gallbladder wall occur in non fasting patient?

Rathachai Kaewlai, MD (รัฐชัย) said...

Good question.
Most of the time we assume that the gallbladder would be contracted in a nonfasting state. However, there was a prospective study of 104 patients (in BMC Medical Imaging) comparing the visualization of GB in patients with fasting and nonfasting; the results showed that there was no statistically significant difference in visualization of GB between the two groups.
Link to article: http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=183866.

The authors concluded that fasting may not be necessary before abdominal ultrasound. In fact, many ER ultrasound practice does not require patients to fast before they come for US.

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