Book contents
- Frontmatter
- Contents
- List of contributors
- Preface
- Acknowledgments
- Section 1 Brain, head, and neck
- Section 2 Spine
- Section 3 Thorax
- Section 4 Cardiovascular
- Section 5 Abdomen
- Case 50 Simulated active bleeding
- Case 51 Pseudopneumoperitoneum
- Case 52 Intra-abdominal focal fat infarction: epiploic appendagitis and omental infarction
- Case 53 False-negative and False-positive FAST
- Liver and biliary
- Case 54 Diaphragmatic slip simulating liver laceration
- Case 55 Gallbladder wall thickening due to non-biliary causes
- Spleen
- Pancreas
- Bowel
- Kidney and ureter
- Section 6 Pelvis
- Section 7 Musculoskeletal
- Section 8 Pediatrics
- Index
- References
Case 55 - Gallbladder wall thickening due to non-biliary causes
from Liver and biliary
Published online by Cambridge University Press: 05 March 2013
- Frontmatter
- Contents
- List of contributors
- Preface
- Acknowledgments
- Section 1 Brain, head, and neck
- Section 2 Spine
- Section 3 Thorax
- Section 4 Cardiovascular
- Section 5 Abdomen
- Case 50 Simulated active bleeding
- Case 51 Pseudopneumoperitoneum
- Case 52 Intra-abdominal focal fat infarction: epiploic appendagitis and omental infarction
- Case 53 False-negative and False-positive FAST
- Liver and biliary
- Case 54 Diaphragmatic slip simulating liver laceration
- Case 55 Gallbladder wall thickening due to non-biliary causes
- Spleen
- Pancreas
- Bowel
- Kidney and ureter
- Section 6 Pelvis
- Section 7 Musculoskeletal
- Section 8 Pediatrics
- Index
- References
Summary
Imaging description
By ultrasound, gallbladder wall edema is present when the gallbladder mural thickness is 3 mm or more (Figure 55.1). The wall may also appear striated, with alternating hypoechoic and hyperechoic layers (Figure 55.2). These imaging features are non-specific in isolation. Additional sonographic signs of acute cholecystitis include the presence of mobile stones or sludge, a non-mobile stone in the gallbladder neck, gallbladder luminal distension, pericholecystic fluid, and extrahepatic and intrahepatic biliary dilation. A sonographic Murphy’s sign (SMS) is positive when there is maximal tenderness over the sonographically localized gallbladder, and negative if the pain is diffuse or localized to a site distant from the gallbladder [1]. If both gallstones and a positive SMS are present with gallbladder wall thickening, the positive predictive value is greater than 90%. Gallbladder wall thickening found in the absence of stones or a SMS has a reported negative predictive value for acute cholecystitis of approximately 95% [1].
Importance
Gallbladder wall edema can be found in patients with both biliary and non-biliary causes of right upper quadrant pain. Additional sonographic features that favor a non-biliary source of the gallbladder wall thickening include sonographic signs of cirrhosis, a hypoechoic liver, and decompressed gallbladder lumen.
- Type
- Chapter
- Information
- Pearls and Pitfalls in Emergency RadiologyVariants and Other Difficult Diagnoses, pp. 182 - 186Publisher: Cambridge University PressPrint publication year: 2013