Gallbladder Wall Thickening Imaging Finding

• 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.