Diagnostic Ultrasound - Abdomen and Pelvis

Hyperechoic Gallbladder Wall
Porcelain Gallbladder
Porcelain Gallbladder
(Left) Oblique transabdominal
ultrasound shows curvilinear
echogenicity ſt in the
gallbladder wall casting dense
posterior acoustic shadowing
. Absence of wall-echoshadow
sign suggests
porcelain gallbladder. (Right)
Axial CECT of the same
patient confirms the thin
diffuse gallbladder wall
calcification ſt in a
contracted gallbladder.
Differential Diagnoses: Biliary System
Gas-Filled Duodenal Bulb
Hyperplastic Cholecystosis
(Left) Transverse ultrasound
shows the duodenal bulb
containing gas . The
gallbladder contains sludge in
this patient with ascites st
and cirrhosis. The duodenum
may be mistaken for a
gallbladder. (Right)
Transverse oblique ultrasound
shows multiple areas of
"comet tail" artifact st
emanating from the thick wall
of the gallbladder.
Reverberation artifact is noted
from bowel and there is
ascites ſt in this patient with
chronic liver disease.
Emphysematous Cholecystitis
Iatrogenic: Post Endoscopic Retrograde
Cholangiopancreatography (ERCP)
(Left) Longitudinal ultrasound
shows the gallbladder fundus
in a diabetic patient with fever
and right upper quadrant pain.
A linear bright echo ſt within
a thick wall produces dirty
shadowing st that is highly
suggestive of gas. This was
confirmed with CT. Surgery
was performed for
emphysematous cholecystitis.
(Right) Transverse oblique
ultrasound shows a bright
linear echo with dirty
shadowing ſt representing
gas in the gallbladder fundus
post ERCP. The gallbladder st
was normal.
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