Sonography of Gall Bladder

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Tyler Weaver
6 years ago
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1 Sonography of Gall Bladder Vikram Dogra,MD Professor of Radiology, Urology and BME Director of Ultrasound Associate Chair of Education and Research University of Rochester, NY

2 Objectives Describe the Congenital anomalies of gallbladder Understand the sonographic features of different types of acute gallbladder diseases. Understand Hyperplastic Cholecystosis. Describe the sonographic features of Gallbladder ployposis And Gallbladder carcinoma 2

3 How to Find GallBladder on Ultrasound? GallBladder neck has a consistent relationship with the origin of the right portal vein. It sits just next to it. 3

4 Duplicate GB

5 Duplicate GB

6 Duplicate GB Differential diagnosis includes Gallbladder diverticula, Gallbladder fold, Phrygian cap, choledocal cyst, Pericholecystic fluid, focal adenomyomatosis, and intraperitoneal fibrous bands 6

7 Ectopic GB

8 Ectopic GB

9 Micro- Gallbladder Rule out Gall stones Dogra,VS

10 Microcystic Gall Bladder Duodenum Gall bladder Rule out Gall stones Dogra,VS

11 Micro GallBladder Micro gallbladder is defined as less than 2-3 cm long and cm wide. Micro gallbladder can be seen most commonly in cystic fibrosis but is also seen in idiopathic neonatal hepatitis and alpha-1antitrypsin deficiency. 11

12 Acute Cholecystitis 12

13 Gangrenous Cholecystitis Right Upper Quadrant pain

14 Gangrenous Cholecystitis

15 Acute Cholecystitis RUQ pain+ GallStones or Impacted gall stone in the neck and Ultrasound Murphy sign Murphy Ultrasound sign is the Key in Gallbladder imaging Gallbladder wall thickening and peri cholecystic fluid are secondary signs. Sloughed Mucous membrane or free floating membrane is Key Air in the gallbladder wall is another important feature. 15

16 Gangrenous Cholecystitis

17 Emphysematous Cholecystitis

18 Emphysematous Cholecystitis 18

19 False Emphysematous Cholecystitis 19

20 GB Perforation

21 GB Perforation

22 50 Year Old Female with RUQ pain Xanthogranulomatous Cholecystitis

23 Xanthogranulomatous Cholecystitis CT T1 T2 T2

24 Xanthogranulomatous Cholecystitis Clinical presentation is usually one of chronic Cholecystitis Age group is sixth and seventh decades of life Incidence is about 1% and 2% of all cases of cholecystitis The pathologic features parallel xanthogranulomatous pyelonephritis. Sonographic,CT and MRI appearance are non-specific Pathology is confirmatory.

25 The WES Triad

26 Significance: Most of the time the WES sign is indicative of an chronic cholecystitis since the WES sign represents a contracted gallbladder with stones. WES triad helps differentiate Bowel from gallbladder. Pitfall: Calcification of gallbladder wall or poor axial resolution may demonstrate only 1 curvilinear echogenic line.

27 Aids Cholangiopathy 27

28 Right Upper Quadrant pain

29 Right Upper Quadrant pain

30 55-year-old patient with recurrent abdominal pain

31 55-year-old patient with recurrent abdominal pain Adenomyomatosis- Fundal Type

32 Adenomyomatosis Smooth Muscle Liver Adenomyo Benign glands Cholesterolosis

33 Adenomyomatosis Reverberation artifact from cholesterol crystals is V-shaped and shorter in length than artifact from air. Sometimes, the calcium present within the sinuses may give rise to twinkle artifact. To Differentiate adenomyomatosis from other causes of gallbladder wall thickening, such as inflammation or carcinoma, is difficult..

34 Adenomyomatosis Hour glass type

35 Fundal Type of adenomyomatosis

36 Diffuse Type of Adenomyomatosis

37 Right Upper Quadrant pain

38 Myth of Adherent Gall Stones Adenomyomatosis

39 Myth of Gall Stones

41 Adenomyomatosis

42 Adenomyomatosis

43 Hyperplastic Cholecystosis. Better term is Hyperplastic Cholecystosis. Adenomyomatosis Cholesterolosis Overgrowth of the mucosa, thickening of the muscular wall, and formation of intramural diverticula or sinus tracts termed Rokitansky-Aschoff sinuses. Adenomyomatosis may involve the gallbladder in a focal, segmental, or diffuse form.

44 GallBladder Polyposis 44

45 GallBladder Polyps Benign Polyps are: Pseudotumors (cholesterol polyps, inflammatory polyps; cholesterolosis and hyperplasia), Epithelial tumors (adenomas) and mesenchymatous tumors (fibroma, lipoma, and hemangioma). Malignant GPs are gallbladder carcinomas. 45

46 GallBladder Polyps Cholesterol polyp is the most common type. Adenomas or adenomyomatous polyps are very rare (0.4% patients who underwent cholecystectomy) Gallbladder polyps larger than 1.5 cm, especially in solitary sessile hypoechogenic polyps, are associated with a risk of malignancy. Polyps that are smaller than 1 cm are monitored for 6 12 months. 46

47 GallBladder Carcinoma 47

48 60 Year Old Female with RUQ Pain

50 GallBladder Carcinoma Adenocarcinoma is most frequent Papillary, Mucinous and Signet cell Sqamous cell, Lymphoma and Mets are least common types. 50

51 GallBladder Carcinoma Gallbladder fossa mass replacing GB and invading Liver is the most common appearance. 25% Polypoid mass, Broad based Mural wall thickening, focal or diffuse, most difficult to diagnose. 51

52 Conclusion Ultrasound Murphy Sign is most important to diagnose Acute Cholecystitis. Free floating membrane is important clue to Gangrenous cholecystitis. Xanthogranulomatous Cholecystitis can not be differentiated from GB carcinoma Aids Cholangiopathy can have marked gallbladder wall thickening. Hyperplastic Cholecystosis can have variable appearance There are no adherent gall stones. 52

53 Gracias por su tiempo 53

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