Gallbladder Wall Thickening Imaging Finding

30 Questions

What is the preferred method for evaluating suspected biliary diseases?

Ultrasound

How wide is the normal gallbladder?

Rarely more than 4 cm

Where is the common hepatic duct usually recognizable?

Near the crossing portal vein

What are indications for gallbladder and biliary tract scanning?

Pain in the right upper abdomen, jaundice, palpable mass, recurrent symptoms of peptic ulcer, and pyrexia of unknown origin

What is the maximum common bile duct diameter near its entrance into the pancreas?

$9$ mm

What is the preferred imaging modality for assessing pancreatic calcification?

X-ray of the upper abdomen

What can calcification within the pancreas produce on ultrasound?

Bright discrete echoes without shadowing

What is a common cause of calcification in the pancreas?

Chronic pancreatitis

What is the normal maximum internal diameter of the pancreatic duct?

$2$ mm

What conditions are usually associated with jaundice and dilatation of the biliary tract?

Tumour of the head of the pancreas or of the ampulla of Vater

What is a characteristic feature of liver abscesses on ultrasound?

Hypochogenic masses with strong back walls

How can subphrenic abscesses be differentiated using ultrasound?

Predominantly echo-free, sharply delineated, crescentic area between the liver and the right hemidiaphragm

What is a distinguishing feature of subcapsular hematomas on ultrasound?

Echo-free or complex (due to blood clots) area located between the capsule of the liver and the underlying liver parenchyma

What should be examined when using ultrasound to search for the cause of pyrexia of unknown origin related to subphrenic abscesses?

Both left and right subphrenic regions and the posterior aspect of the lower chest

What is a reliable method for detecting intrahepatic haematomas?

Ultrasound

What is the function of the gallbladder?

Storing bile to help break down fats

What can cause a distended gallbladder?

Dehydration, low-fat diet, intravenous nutrition

How can a distended gallbladder be diagnosed?

Fatty meal and ultrasound examination

What are potential causes of a distended gallbladder with thickened walls and filled with fluid?

Empyema and mucocele

What can nonmobile internal echoes without shadowing indicate during an ultrasound scan of the gallbladder?

Polyp or malignant disease

What are the imaging techniques used to evaluate gallbladder disease?

Sonography, CT, and MRI

What is considered the normal gallbladder wall thickness on sonography?

Less than 3 mm

Which condition can lead to gallbladder wall thickening?

Chronic renal insufficiency

What is the role of ultrasound in evaluating gallbladder disease?

It is used as the initial imaging technique for gallbladder disease

What are the potential consequences of misinterpreting gallbladder wall thickening findings?

Delayed treatment and unnecessary surgeries

Which of the following is an important ultrasound finding for high-risk individuals in the diagnosis of pancreatic carcinoma?

Main pancreatic duct (MPD) dilatation

Which scanning maneuvers are important for both screening for pancreatic carcinoma and follow-up of high-risk individuals?

Right lateral decubitus, sitting, and upright positions

What can improve the visualization of the tail of the pancreas during ultrasound?

Liquid-filled stomach method

What can cause diffuse enlargement of the pancreas and elevated serum amylase on ultrasound?

Acute pancreatitis

How do true pancreatic cysts typically appear on ultrasound?

Smooth, echo-free cavities filled with fluid

Study Notes

Biliary system diseases are common in medical practice, and ultrasound is the preferred method for evaluating suspected biliary diseases.
The gallbladder appears as an echo-free, pear-shaped structure on a longitudinal scan. Its normal width is seldom more than 4 cm, and it may be located in various positions.
The common hepatic duct is usually recognizable near the crossing portal vein, and its cross-section at this level should not exceed 5 mm.
The gallbladder may not be visible by ultrasound due to several reasons, including non-fasting status, unusual position, congenital absence or surgical removal, or inexperience of the examiner.
Non-visualization of the gallbladder is rare in pathological conditions other than congenital absence or surgical removal.
Pain in the right upper abdomen, jaundice, palpable mass, recurrent symptoms of peptic ulcer, and pyrexia of unknown origin are indications for gallbladder and biliary tract scanning.
Indications for gallbladder and biliary tract scanning include pain, jaundice, palpable mass, recurrent symptoms of peptic ulcer, and pyrexia of unknown origin.
The gallbladder may not be visible by ultrasound due to several reasons, including non-fasting status, unusual position, congenital absence or surgical removal, or inexperience of the examiner.
A distended gallbladder is usually not a serious condition but can lead to potentially life-threatening complications if left untreated.
The common bile duct diameter is variable but should not exceed 9 mm near its entrance into the pancreas.
Ultrasound (US) is used widely for mass screening due to its simplicity and non-invasiveness, but visualizing the entire pancreas can be difficult due to its complicated anatomy, obesity, and gas
US plays a crucial role in the diagnosis of pancreatic carcinoma (PC) with main pancreatic duct (MPD) dilatation (3 mm or more) and pancreatic cysts (5 mm or larger) being important US findings in high-risk individuals (HRIs), who should be monitored periodically
Scanning maneuvers, such as right lateral decubitus, sitting, and upright positions, are important for both screening for PC and follow-up of HRIs
US can be challenging to visualize the tail of the pancreas due to gas and stool, and poor visualization can be improved by the liquid-filled stomach method
Normal pancreas has the same echogenicity as the adjacent liver and appears homogeneous; certain anatomical landmarks should be identified during scanning including the aorta, inferior vena cava, superior mesenteric artery, splenic vein, and superior mesenteric vein
Pancreatic size and shape vary widely; a small, non-homogeneous pancreas may be due to chronic pancreatitis or a tumor
Acute pancreatitis can cause diffuse enlargement of the pancreas, which may be normal or hypochogenic compared with the liver, and is associated with elevated serum amylase and local ileus
Focal enlargement (noncystic) of the pancreas cannot be distinguished from focal pancreatitis or pancreatic tumor by US alone, and a biopsy may be necessary if the pattern is mixed
True pancreatic cysts are rare and appear as smooth, echo-free cavities filled with fluid; pseudocysts following trauma or acute pancreatitis are not uncommon and can be complex in the early stages with ill-defined walls and internal echoes, but eventually become smooth-walled and echo-free.

Test your knowledge on interpreting gallbladder wall thickening imaging findings and differentiating between symptomatic and asymptomatic patients. Learn to identify potential misinterpretations and prevent unnecessary cholecystectomies.

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