67 Thickened Gallbladder Wall (>3 millimeters)

CLINICAL IMAGAGINGAN ATLAS OF DIFFERENTIAL DAIGNOSIS

EISENBERG

DR. Muhammad Bin Zulfiqar PGR-FCPS III SIMS/SHL

• Fig GI 67-1 Acute cholecystitis. Marked thickening of the gallbladder neck (1.1 cm between the cursors). There is a densely echogenic stone (arrow) with posterior acoustic shadowing in the neck of the gallbladder.

• Fig GI 67-2 Acalculous cholecystitis. Enlarged gallbladder with a thickened, edematous wall (arrows). There is no evidence of gallstones or posterior acoustic shadowing.

• Fig GI 67-3 Xanthogranulomatous cholecystitis. Longitudinal sonogram of the right upper quadrant shows disruption of the mucosal line of the gallbladder (arrow), which contains echogenic material. There is pericholecystic fluid, focal hypoattenuation in the adjacent liver, and loss of the normal plane between the gallbladder and liver.87

• Fig GI 67-4 Hypoalbuminemia with marked ascites. Thickening of the gallbladder wall (arrow).

• Fig GI 67-5 Ascites. A large amount of sonolucent ascitic fluid (a) separates the liver (L) and other soft-tissue structures from the anterior abdominal wall. Note the relative thickness of the gallbladder wall (arrow).

• Fig GI 67-6 Congestive heart failure. Sagittal sonogram shows edema of the wall of the gallbladder (arrowheads), pericholecystic fluid (FF), and distension to the inferior vena cava (IVC).88

• Fig GI 67-7 Acute viral hepatitis. Sagittal sonogram shows a tiny, slitlike gallbladder lumen (*) with massive “onion-peel” edema of the wall (arrowheads).88

Fig GI 67-8 Cirrhosis. Sagittal sonogram shows a thickened gallbladder wall (arrowheads) and free fluid (FF).88