GB US

Describe this image of the GB

GB septations

Focal GB thickening can be caused by

Stones, polyps, masses or adenomyomatosis

Non-Biliary edema of GB Wall traits

• thicker than that caused by Cholecystitis

• Concentric thickening with a layered appearance with both linear hypoechoic (edema) and echogenic components

• Often assoc w/ascites

What can simulate GB thickenining and is associated with Portal Vein Thrombosis?

GB varices, commonly associated with portal vein thrombosis, may simulate wall thickening but are distinguishable on color Doppler

Biliary Causes of GB thickening

• Cholecystitis

• Adenomyomatosis

• Cancer

• AIDS cholangiopathy

• Sclerosing cholangitis

Cholangiopathy

any disease or damage affecting the bile ducts

Secondary causes of GB diffuse thickening

• hepatitis

• pancreatitis

• heart failure

• hypoprotenemia

• Cirrhosis

• Portal hypertension

• Lymphatic obstruction

• Mononucleosis

These picture are showing what?

Gallbladder (GB) wall thickening in different patients.

• Longitudinal views of the GB show diffuse thickening (cursors) secondary to congestive heart failure (A), cirrhosis and portal hypertension (B), and acute hepatitis (C). A nodular liver surface is seen in the patient with cirrhosis (arrow). In the patient with hepatitis, the GB lumen is completely contracted and the coapted mucosal layers are seen as a thin echogenic line in the center of the GB.

this a picture of what?

GB varices with sludge in the lumen

what chance to GB polyps have of turning cancerous

Risk of malignancy extremely small and related to size

US findings of GB polyp

• Elevations or protuberances from the GB wall

• Usually <1 cm; often multiple

• Immobile; nonshadowing

• Important to determine whether pedunculated or sessile

• Doppler flow may differentiate true polyp from sludge ball; lack of Doppler flow does not exclude a polyp.

GB Carcinoma is associated ? percentage with Gallstones

95% associated with gallstones

Often appears as soft tissue mass centered in the GB fossa that completely or partially obliterates lumen

GB carcinoma

how big are gb carcinoma’s typically?

greater than 1cm (usually much larger) and sessile

GB metastases most often come from?

melanoma

if you see a Mass centered in gallbladder fossa with associated stones Eccentric, irregular wall thickening Bulky intraluminal polypoid mass…. what other areas should you check or look for?

• invasion of liver

• Obstruction of Bile ducts or vessels

• Lymphadenopathy

• nodal mets

What are these pictures of?

GB carcinoma

These pictures represent

adenomyomatosis

This condition is char. by an acquired mucosal hyperplasia and thickening of the muscularis propria of the GB which causes Mucosal invaginations into the muscular wall form cystic spaces (Rokitansky-Aschoff sinuses)

adenomyomatosis

3 types of adenomyomatosis

1. Segmental annular thickening; often narrows lumen

2. Localized mass; most often fundal

3. Diffuse wall thickening

Classic sign of adenomyomatosis

• Creates classic bright reflections with short comet-tail artifacts (most common finding)

• Seen almost exclusively on near wall since comet tails only visible in background of anechoic bile within lumen

Characterized by calcification of GB wall and Associated with chronic GB inflammation

Porcelain GB

us findings of Porcelain GB

• Echogenic arc with dense posterior shadowing

• Less extensive calcification produces only partial shadowing; back wall of GB remains visible

• In early cases, only segments of GB wall may be affected

These pics are of what GB condition

porcelain gb

(A) Transverse view shows an echogenic superficial GB wall with complete shadowing of the remainder of the GB lumen and back wall.

(B) Longitudinal view of the GB shows an echogenic superficial wall with shadowing of the deep GB wall in the region of the fundus but sound penetration and visualization of the back wall in the body of the GB (arrows).

(C) Longitudinal view shows scattered areas of wall calcification (arrows) and a stone (S) in the GB neck.