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ECR 2018 / C-2568
Infrequent differential diagnoses to consider in thickening of the gallbladder wall
Congress: ECR 2018
Poster No.: C-2568
Type: Educational Exhibit
Keywords: Inflammation, Cancer, Education, Complications, Ultrasound, MR, CT, Biliary Tract / Gallbladder, Anatomy, Abdomen
Authors: M. Perez, J. P. Espinosa, V. García, B. Molinares; Medellin, Antioquia/CO
DOI:10.1594/ecr2018/C-2568

Background

 

Thickening of the gallbladder wall is a frequent finding at images. The most common diagnosis is acute cholecystitis.


The images findings are non-specific and can be found in extracholecystic pathological conditions.


We describe and illustrate the infrequent causes of a thickened gallbladder wall like acquired gastrointestinal fistula, AIDS cholangiopathy and gallbladder trauma. 

 

Isolated traumatic gallbladder injuries are uncommon and difficult to diagnose. Motor vehicle collision is the most common cause of gallbladder injury. The delay in diagnosis causes a significant increase in the morbidity and mortality associated with traumatic gallbladder injuries.

 

Severe gallbladder injury can take the form of contusion, laceration, and avulsion. Gallbladder contusion, or intramural hematoma, is most often diagnosed at the time of laparotomy and is thought to be underreported. Gallbladder laceration, or rupture, is the most commonly reported gallbladder injury

 

Hepatobiliary diseases have been described with increasing frequency among patients with the acquired immunodeficiency syndrome (AIDS). In patients presenting with a cholestatic pattern of liver function test abnormalities, cholangiop- athy associated with human immunodeficiency virus (HIV) infection should be suspected. 

 

Cryptosporidium and CMV were initially de- scribed as the causative agents in AIDS-related cholangitis. Although other pathogens have been discovered with increasing frequency, Cryptosporidium remains the most commonly identified cause of AIDS-related cholangitis. It has been identified in the bile ducts or stools in 20 to 62% of patients with AIDS-related cholangitis. CMV is probably the second most common cause of AIDS- related cholangitis, having been described in 23 to 42% of patients.

 

 

Abdominal sonography and CT are effective in identifying biliary disease in patients with AIDS, but cholangiography is necessary to display the precise anatomic irregularities.  

 

Spontaneous internal biliary fistulas represent a complication of cholelithiasis or choledocholithiasis in over 90% of cases. Infrequent causes include peptic ulcer disease, ma- lignancy, and prior surgery.

Cholecystoduodenal fistulas are the most common type, followed by cholecystocolic and choledochoduodenal fistulas.

Distal small-bowel obstruction from an impacted ectopic gallstone, so-called gallstone ileus, is an unusual complication of chronic cholecystitis and affects only a minority of patients with chole- cystoduodenal fistulas. Gallstones that result in intestinal obstruction typically exceed 2 cm in diameter.  Obstruction at the level of the gastric outlet or duodenum represents a specific subset of gallstone ileus that is referred to as Bouveret syndrome. Surgery is indicated to relieve the obstruction in cases of gallstone ileus, and surgical correction is required for the biliary fistula, to prevent future complications.

 

 

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