|ECR 2018 / C-2568|
|Infrequent differential diagnoses to consider in thickening of the gallbladder wall|
Findings and procedure details
The radiologist need to know different findings in US, CT and MR on the basis of the patterns and to evaluate the diagnostic value of images in infrequent diseases caracterized by thickening of the gallbladder wall.
MR findings of gallbladder wall thickening were evaluated in sequences for MR cholangiograph. The layered pattern of thickened wall was classified into patterns. MR findings of a layered pattern of thickened gallbladder were well correlated with clinics.
The diagnosis of gallbladder injury is made by detecting blood within the gallbladder lumen. Using sonography, echogenic fluid will be detected within the gallbladder.
CT most confidently achieves the diagnosis of gallbladder injury. Blood in the gallbladder most reliably presents as high-density fluid within the gallbladder lumen. Other CT findings that are suggestive of gallbladder injury include thickening or indistinctness of the gallbladder wall and active arterial extravasation into the lumen.
Complete avulsion of the gallbladder results in displacement of the gallbladder from its fossa. Pericholecystic fluid and collapsed gallbladder lumen are less specific indicators of gallbladder trauma. Associated intraabdominal injuries include liver laceration and duodenal hematoma.
Peritoneal lavage may be negative in the setting of an isolated gallbladder avulsion injury because a bile leak and hemorrhage from a ruptured gallbladder may be contained within the extraperitoneal gallbladder fossa.
The diagnosis of AIDS-related cholangitis is based on the typical cholangiographic findings in patients with advanced HIV disease, supported by the demonstration of a pathogen associated with the disease.
Four distinct patterns of AIDS-related cholangitis seen on cholangiography: papillary stenosis occurs in approximately 15- 20% of patients, causing dilatation of the common bile duct to greater than 8 mm and a smooth distal tapering of the duct. Sclerosing cholangitis is characterized by focal strictures and dilatation of the intrahepatic and extrahepatic ducts; in this pattern, which occurs in 20% of patients, the calibre of the extrahepatic ducts is normal. Combined papillary stenosis and sclerosing cholangitis occurs in 50% of patients therefore, the papilla is involved in 70% of patients. Finally, long extra hepatic bile duct strictures, in which a 1e2 cm stricture is present, occur in approximately 15% of patients.
In nearly all the reported cases of this entity, the anatomic abnormalities of the biliary tract have been demonstrated on ERCP and the diagnosis made based on the direct cholangiographic features indistinguishable from those of primary sclerosing cholangitis (PSC).
Pneumobilia seen on imaging studies strongly suggests the presence of an internal biliary fistula in the absence of prior sphincterotomy, surgical bypass proce- dure, recent endoscopic retrograde cholangiopancreatography, or passed common duct stone. The Rigler triad of small-bowel obstruction, pneumobilia, and ectopic gallstone is virtually pathognomonic for gallstone ileus but is present on con- ventional radiographs in only 30%–35% of cases.
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