Gallbladder Flashcards
USF of cholelithiasis
Highly reflective echogenic focus in GB lumen
PAS
Gravity dependant movement
Checklist for cholelithiasis
Exclude cholecystitis, cholangitis and pancreatitis
Worse after meals, female, 40, obese
Difference between echogenic bile/blood clots/parasites Vs cholelithiasis
Mobile medium/high level echo without acoustic shadowing
USF of gallbladder polyp
Multiple small no shadowing lesions attached to GB wall
Mostly middle 3rd
Wall intact
No LN or invasion
Avascular
Further imaging if more than 10mm, sessile, singularity, internal vascularity
Checklist for GB polyp
Demonstrate immobility
USF of thickened GB wall
More than 3mm
Hypoechoic thickening
Linear echogenic striations within hypoechoic area
Checklist for gallbladder wall thickening
Exclude gallbladder inflammatory condition and systemic illnesses
USF for acute cholecystitis
Calculous - gallstone impaction, positive Murphy ax, GB thickening more than 4mm, sludge, pericholecystic fluid.
Acalculous - same as above without stone
Diagnostic checklist for cholecystitis
Exclude calculous Vs acalculous, perforated ulcer or acute pancreatitis
USF of chronic cholecystitis
Diffuse GB thickening
Contracted GB
Gallstones in all cases
Absence of pericholecystic fluid
Lack of hyperemic changes within GB wall
USF of porcelain GB
Dense PAS
Echogenic curvilinear line in GB fossa
Coarse echogenic foci in GB wall with acoustic shadowing
USF of GB carcinoma
Large GB mass invading liver
Polypoid intraluminal mass of irregular shape
Diffuse or focal irregular mural thickening or destruction of GB
Regional met LN
Checklist for GB carcinoma
Mass infiltrating GB fossa with liver invasion
Large polypoid GB mucosal mass with flow
USF of biliary Ductal Dilatation
Tubular anechoic branching structures accompanying portal veins
• Irregularity and tortuosity of dilated ductal walls
Central stellate confluence of tubular structures proximally at liver hilum
• Acoustic enhancement posterior to dilated ducts
• Dilatation of common hepatic/bile duct> 6-7 mm
USF of choledochal cyst
Location: May involve intrahepatic bile ducts, extrahepatic ducts, or both
• Cystic extrahepatic mass separated from gallbladder and communicates with common hepatic or intrahepatic ducts
US findings of cholesocholithiasis
highly echogenic foci with posterior acoustic shadowing
• Small « 5 mm) or soft pigmented stones may not produce posterior shadowing
• Larger stone may cause biliary obstruction with focal intrahepatic ductal dilatation
• CBDstones are most commonly located in the region of ampulla of Vater, high chance of being obscured by bowel gas
Checklist for choledocholithiasis
Rule out other causes of “CBDobstruction”
• Echogenic filling defects casting posterior acoustic shadowing associated with dilatation of CBD/intrahepatic bile ducts
USF of biliary ductal gas
Best diagnostic clue: Bright echo genic foci in linear configuration following portal triads casting posterior acoustic shadowing
• In non-dependent position: Left lobe biliary ducts with patient in supine position
Us findings of cholangiocarcinoma
Best diagnostic clue: Intra- or extra-hepatic mass with infiltrative margins and dilatation of biliary ducts
• Extrahepatic cholangiocarcinoma (EHC) (- 90%); 2/3 found in common bile duct (CBD)/common hepatic duct (CHD)
• Intrahepatic cholangiocarcinoma (IHC)- 10% • Intrahepatic cholangiocarcinoma • Isolated intrahepatic ductal dilatation without extrahepatic duct dilatation • Mass with ill-defined margin, mostly hyperechoic (75%) and heterogeneous
• Klatskin tumor • Dilatation of intrahepatic ducts without extrahepatic ductal dilatation • Nonunion of right and left hepatic ducts
Primary tumor may not be discernible, or appears as small infiltrative iso/hyperechoic mass in hilar region
• Extrahepatic cholangiocarcinoma • Dilatation of intrahepatic and proximal extrahepatic bile duct • Ill-defined, solid, heterogeneous mass within or surrounding duct at point of obstruction
Checklist for cholangiocarcinoma
Rule out biliary and pancreatic pathologies that obstruct extrahepatic bile duct
