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:

  1. Thank you krub..

    Is the "Pericholecystic fluid" more specific krub?

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  2. 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.

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

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  4. 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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