Diagnostic Ultrasound - Abdomen and Pelvis

Dilated Gallbladder
○ Distended nontender palpable gallbladder in the setting
of jaundice is rarely due to obstructing gallstones
– Stones are associated with chronic inflammation and
lack of gallbladder distensibility
– Or they produce acute obstruction with less
gallbladder distension
○ Neoplasms such as pancreatic carcinoma are more likely
as they produce chronic lower grade obstruction
Choledochal Cyst
• Large cyst may compress or obstruct the gallbladder or
mimic a distended gallbladder
• Associated with biliary dilatation
• Can be confirmed with MRCP or ERCP
Infections Causing Acalculous Cholecystitis
• Ultrasound findings similar to acute acalculous cholecystitis
• Bacteria
○ Salmonella typhi: Acute and chronic infection
○ Escherichia coli, Klebsiella, Staphylococcus species
○ Leptospirosis
• Viral
○ Hepatitis A, B viruses, CMV, dengue virus
• Diagnoses made by clinical picture and laboratory tests
• Hydatid
○ In endemic regions
○ Intraluminal gallbladder membranes or cysts
○ Curvilinear calcifications
○ Typically associated with liver cysts
• Ascariasis
○ Intraluminal living or dead worms
○ Obstruct cystic duct causing cholecystitis
• Malaria
○ Can cause acalculous cholecystitis
Henoch-Schönlein Purpura
• Associated with gallbladder hydrops or acalculous
cholecystitis
• Characteristic skin rash
Gallbladder Torsion/Volvulus
• Elderly thin women with wandering gallbladder
• Features of cholecystitis but difficult preoperative diagnosis
• Markedly dilated gallbladder
• May be displaced from normal location
• Twisting of the cystic duct and artery
○ Whirl sign on color Doppler
Systemic Lupus Erythematosus
• Acalculous cholecystitis due to vasculitis of gallbladder wall
and bile ducts
• Treated nonsurgically with corticosteroids
SELECTED REFERENCES
1. Eachempati SR et al: Acute cholecystitis in the sick patient. Curr Probl Surg.
51(11):441-66, 2014
2. Revzin MV et al: The gallbladder: uncommon gallbladder conditions and
unusual presentations of the common gallbladder pathological processes.
Abdom Imaging. Epub ahead of print, 2014
3. Sebastian S et al: Managing incidental findings on abdominal and pelvic CT
and MRI, Part 4: white paper of the ACR Incidental Findings Committee II on
gallbladder and biliary findings. J Am Coll Radiol. 10(12):953-6, 2013
4. Boonstra EA et al: Torsion of the gallbladder. J Gastrointest Surg. 16(4):882-
4, 2012
5. Charalel RA et al: Complicated cholecystitis: the complementary roles of
sonography and computed tomography. Ultrasound Q. 27(3):161-70, 2011
6. Gore RM et al: Gallbladder imaging. Gastroenterol Clin North Am. 39(2):265-
87, ix, 2010
Differential Diagnoses: Biliary System
Physiologic
Physiologic
(Left) Transverse oblique
ultrasound of the gallbladder
in a ventilated patient on total
parenteral nutrition. The
gallbladder is distended st
with minimal sludge ſt.
There is no wall thickening.
(Right) CECT of the same
patient shows the distended
gallbladder st and cystic duct
without signs of
inflammation or obstructing
lesion.
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