Gallbladder Sludge on Ultrasound
Gallbladder sludge is a common finding on ultrasounds done of the gallbladder. The gallbladder stores bile used to help with digestion. Bile passes from the gallbladder into the bile duct and into the intestine. Biliary sludge is also called bile sand, debris or thick bile. It consists of sediment that has precipitated from bile in the gallbladder.
Gallbladder sludge can cause problems such as biliary colic or gallbladder attacks, pancreatitis or inflamed pancreas and inflamed bile ducts or cholangitis. Many patients remain without symptoms. Predisposing factors include alcohol use, pregnancy, rapid weight loss, severe illness and following surgery.
On ultrasound, sludge most commonly forms a fluid-fluid level. The sludge is seen at the bottom of the gallbladder forming a sharp interface with the normal bile above it. Sludge is usually whiter in appearance then the normal bile. There is no shadow behind it like you see with gallstones. Sludge will slowly change when the patient is moved into different positions.
Less common appearances of sludge can be mass like, called tumefactive sludge. This has the appearance of a gallbladder mass. Unlike a true solid mass, there is no visible blood flow and it can sometimes move in position. In those cases where it remains unclear, an MRI exam may help with sorting out the possibilities. Another option is a short term follow up ultrasound in 2-4 weeks. A mass will not go away whereas sludge may clear or have a different appearance.
Complications of sludge are similar to gallstones. The sludge can block the gallbladder and cause a Gallbladder attack or acute cholecystitis (inflamed gallbladder). The sludge may pass into the bile duct and cause a blockage, pain and inflammation. The sludge can also cause pancreatitis or inflamed pancreas.
Many people are asymptomatic and require no treatment. A change in lifestyle or removal of a risk factor may make sludge go away. Surgery may be needed for those who have pain or other complications. Additional imaging other than ultrasound may be needed if a complication is suspected or it is not certain that sludge is causing the symptoms you are having.
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- Gallbladder sludge
Citation, DOI, disclosures and case data
At the time the case was submitted for publication Chris O'Donnell had no recorded disclosures.
Presentation
Painless right upper quadrant mass ?enlarged liver.
Patient Data
Distended gall bladder containing echogenic, gravity dependent, mobile, biliary sludge with calculi. No specific features of cholecystitis ie no wall thickening or surrounding edema (nor pain on ultrasound probing of the fundus).
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- v.20(80); 2020 Apr
Optimization of diagnostic ultrasonography of the gallbladder based on own experience and literature
Andrzej smereczyński.
Self-education Ultrasonographic Association, Department of Genetics and Pathomorphology, Pomeranian Medical University, Szczecin, Poland
Katarzyna Kołaczyk
Elżbieta bernatowicz.
Although transabdominal imaging of the gallbladder has become a gold standard, new light should be shed on some aspects, which will prove useful in everyday practice. Therefore, based on our own experience and the available literature, we would like to draw attention to those elements of gallbladder ultrasound imaging which may increase its diagnostic efficacy. The paper draws attention to the difficulty in assessing certain anatomical structures, such as the inferior wall, the bottom and the region of the neck of the gallbladder, and offers ways to improve their imaging. We also emphasized the negative effects of duodenal and transverse colon (along with their contents) adhesion to the bottom of the gallbladder on the correct diagnosis. Due to the importance of size in the management strategy for detected gallbladder polyps, we suggest their measurement on an image enlarged with the zoom function. This technique also allows for an accurate assessment of the shape and echostructure of these lesions. An enlarged image of a polyp makes it possible to trace its behavior in time. We also remind that the hepatic wall of the gallbladder is the only site allowing for a reliable wall thickness measurement. We also pointed to the importance of changing patient’s position when assessing the mobility and the nature of lesions. Altering patient’s position during examination may help detect anomalies in the form of a floating gallbladder, which may promote its torsion. Finally, pathologies whose diagnosis may be facilitated by color-coded blood flow imaging are also presented. The issues discussed in this paper are only a fraction of problems faced by an ultrasound operator in the field of gallbladder diagnostic imaging. However, the proposed ultrasound approaches should help solve some of these problems in everyday practice.
Introduction
The introduction of harmonious and spatially complex imaging with a simultaneous reduction of image speckles have contributed to significant advances in gallbladder ultrasonography. Furthermore, optimization of this technique was achieved by constructing high-resolution broadband transducers with 3D and 4D options for organ imaging. This diagnostic arsenal was further enriched with endoscopic, laparoscopic and contrast-enhanced ultrasound (CEUS), as well as elastography and automatic organ segmentation, which was achieved using a special algorithm ( 1 – 11 ) . Ultrasonography has long been a method allowing for precise cytological diagnosis of lesions by means of transabdominal and endoscopic ultrasound-guided fine needle aspiration biopsy ( 12 – 14 ) . Finally, the technique has gained acceptance as a treatment method for acute cholecystitis in patients disqualified from cholecystectomy by percutaneous or endoscopic aspiration of the infected content or by a temporary gallbladder drainage ( 14 – 16 ) .
Digital ultrasonography with a variety of options to improve the image and different modes of color-coded blood flow is usually used in daily practice. In our opinion, the best protocol for gallbladder ultrasonography was presented by Hertzberg and Middleton, the authors of “Ultrasound: the requisites” ( 17 ) . A comprehensive examination of this organ involves scanning in various positions (supine, prone, oblique and upright). This allows for almost complete visualization of gallbladder walls and content, as well as the mobility of lesions inside the gallbladder. In this paper, we would like to draw attention to some elements of gallbladder ultrasound, which may increase its diagnostic efficacy in everyday clinical practice, based on our own experience and the available literature.
To begin with, it seems important to specify which parts of the gallbladder are difficult to evaluate.
Anatomical and topographic conditions
Figure Figure1 1 shows an optimal view of the gallbladder in two cross-sections in upright position. This image was obtained owing to the liver, which is an acoustic window for all parts of the gallbladder, including the fundus. The posterior wall of the gallbladder closely adheres to the duodenal bulb, which is filled with liquid in this case. The image may be unclear due to the presence of gas generating reflections in the gallbladder, which mimic biliary sludge. This acoustic effect also blurs the outline of the gallbladder wall in this region. Changing patient’s position allows for accessing the previously inaccessible wall segments (Fig. (Fig.2). 2 ). A situation when the gallbladder fundus protrudes beyond the border of the liver is another common anatomical variant (Fig. (Fig.3). 3 ). In such cases, when a convex transducer with a mean frequency of 3.5 MHz is used, the image of the gallbladder fundus becomes blurred and, consequently, lesions in this location may be overlooked. This is the most common location of focal adenomyomatosis, which is found in 1–9% of cholecystectomy specimens ( 18 ) . Our observations indicate that ultrasonography often fails to detect this type of pathology at this site (Fig. 4 A and Fig. 4 B ). A linear 7–12 MHz transducer allows for obtaining a clearer image of the gallbladder fundus in patients without overweight or adiposity (Fig. (Fig.5 5 and Fig. Fig.6). 6 ). Significant diagnostic difficulties occur in the case of pathological lesions located in the neck region in patients with a large anteroposterior epigastric size. Imaging improvement may be expected after moving the focus to the ROI (Fig. (Fig.7). 7 ). However, it should be kept in mind that the cystic duct may be long and tortuous, which will pose a real challenge in such cases (Fig. (Fig.8). 8 ). Horizontal position of the gallbladder at the level of the costal arch will pose another imaging difficulty (Fig. (Fig.9). 9 ). This is a situation when the gallbladder walls are positioned least favorably, i.e. parallel to the ultrasound beam. This will require applying the transducer at different sites along with adjusting patient’s position and the optimal level of breath hold.
An entire gallbladder is clearly visible in two cross-sections due to hepatic acoustic window for all its parts
Two oblique cross-sections of the gallbladder. Its walls may be assessed only when contacting the liver. Gas in the duodenal bulb causes distinct reflections, which make it impossible to assess the gallbladder wall at this site
The arrow indicates the gallbladder fundus, which is difficult to assess as it is not covered by the liver
Gallbladder. A. Two typical cross-sections, with no detectable lesions. B. The same case. Focusing on the assessment of the gallbladder fundus allowed to identify signs of focal adenomyomatosis
An image of adenomyomatosis in the gallbladder fundus, obtained with a linear transducer. The arrows point to the Rokitansky-Aschoff sinuses
Another example of adenomyomatosis in the gallbladder fundus visualized with a linear transducer. The Rokitansky-Aschoff sinuses are clearly seen
The arrows indicate a small stone wedged in the neck of the gallbladder, which is difficult to visualize, on two cross-sections
A long (40 mm), bent cystic duct is seen on the sonogram
Difficult gallbladder assessment due to its horizontal position at the level of the costal arch
Pseudolesions of the gallbladder
Pseudolesions due to adherence of neighboring organs are another issue to discuss. The duodenal bulb may sometimes protrude into the gallbladder fundus, thereby mimicking a solid tumor, a liquid lesion or a stone (Fig. (Fig.10 10 ) ( 19 ) . In this situation, it is worth resuming gallbladder assessment as the bulb may shrink during this time and expose the fundus. In the case of further doubts, an intake of a glass of water by the patient helps resolve the situation. The presence of fluid, often accompanied by duodenal gas, ultimately helps make a correct diagnosis.
Divided sonogram. The arrow on the left points to a pseudotumor of the gallbladder fundus due to duodenal bulb compression. After a while the entire gallbladder fundus was visible, as can be seen on the right side of the image
The transverse colon filled with gas or stool may also mimic stones in the gallbladder fundus. Gas collections in the intestine cause the so-called dirty acoustic shadow. If this occurs, the transducer should be positioned in the long axis of the intestine, contributing to the visualization of the haustration of the transverse colon (Fig. (Fig.11 11 ).
Divided sonogram. The left-sided arrow indicates a lesion generating dirty shadow in the field of the gallbladder fundus. A segment of transverse colon with accentuated haustration (arrows), which is the cause of this acoustic phenomenon, is seen on the right side of sonogram
Measurement of gallbladder lesions
The examples in section 1 indicate that a reliable measurement of the thickness of the gallbladder wall is only possible in the hepatic wall. It is advisable to measure it on an enlarged sonogram using the zoom function (Fig. (Fig.12 12 ).
The measurement of the actual gallbladder wall thickness is only possible on the hepatic wall
The measurements are often performed using images obtained with a convex transducer (usually in one cross-section), especially in the case of polyps. This is not a precise method, as documented in Fig. Fig.13. 13 . In such cases, it is worth zooming the image to assess the lesion in two dimensions (Fig. (Fig.14). 14 ). Effort should be made to visualize the lesion in the largest possible dimensions as polypoid formations may be multi-shaped (Fig. (Fig.15). 15 ). This is important due to the management strategy in gallbladder polyps. Resection is recommended for polyps ≥10 mm as they significantly increase the risk of dysplasia or cancer ( 2 – 4 , 20 , 21 ) . An enlarged image allows tracking the polyp’s behavior over time with greater precision. According to Sun et al . ( 21 ) , growth of ≥3 mm in 6 months may be an indication for cholecystectomy. An enlarged sonogram may be used to search for smaller, often multiple, lesions. It is recommended that ultrasound surveillance of lesions is performed by the same physician.
Divided sonogram. A non-enlarged image of a polyp is seen on the left. The same polyp in a zoomed image on the right. The difference is the size is 1.5 mm
Divided sonogram. The dimensions of the same polyp in a non-zoomed image on the left and in a zoomed image on the right
Divided sonogram. Accurate assessment of shape and size of a gallbladder adenoma (right) is possible only using an enlarged image
Lesion mobility assessment
Each detected gallbladder lesion should be assessed for mobility as this allows for accurate diagnosis in most cases. Mobility is typically shown by deposits, a mass of biliary sludge, parasites and gas. A typical supine or left oblique position may be associated with difficulties in detecting microcholelithiasis adhering to the wall adjacent to the duodenum, which is often filled with gas generating bright reflections. Right oblique position is useful in such cases. This allows for visualizing small deposits on the hepatic background and for a more reliable estimation of their number (Fig. 16 A and Fig. 16 B ).
Gallbladder. A. An image obtained in two oblique projections in supine position. Stones cannot be seen in these projections. B. The same gallbladder. Microstones were observed only in the right oblique position
Another issue associated with gallstones in the gallbladder is their behavior depending on body position during scanning. Cholesterol stones account for a vast majority, i.e. 75%, of biliary stones. Since their specific gravity is lower than that of bile, they migrate to the fundus of the gallbladder, which is often the highest part of this organ, when in upright position. Figure Figure17 17 shows gallbladder stone migration upon changing patient’s position from a supine to upright position. Providing this information to patients should prevent them from lying down within an hour after a meal to avoid stone migration into the neck upon shrinking of the gallbladder. This relationship between stone location and body position is a common cause of biliary colic in the evening or at night.
Variable location of gallbladder microstones in a supine and upright position
Changes in position can even affect the gallbladder itself, which results from its faulty attachment to the liver (Fig. 18 A and Fig. 18 B ). A mobile gallbladder, which is also referred to as a floating gallbladder, will be prone to torsion. This complication usually occurs in emaciated, elderly females. This is a serious life-threatening condition ( 22 – 24 ) .
A floating gallbladder with a stone. A. In a supine position, the gallbladder (GB) is located to the left of the aorta (A). S – Spine. B. The same gallbladder in the position on the right side. The gallbladder (GB) migrated to the right of the aorta (A)
Vascularization of lesions
The introduction of high-sensitivity blood flow imaging methods is an additional important factor supporting gallbladder ultrasound diagnosis. The degree of vascularization of lesions detected in the gallbladder and its walls should be assessed in various pathologies during each examination. Color Doppler should be set at slow blood flow, i.e. 2–10 cm/s ( 2 ) .
This modality is recommended in the following situations:
- assessment of the degree of gallbladder wall congestion and/or ischemia in cholecystitis ( 25 ) ;
Divided sonogram. Size and vascular pattern of a gallbladder adenoma
Divided sonogram. Vascularized gallbladder cancer mimicking a mass of biliary sludge
A. Portal vein thrombosis in cirrhosis. Gallbladder wall blood vessels were visualized with Color Doppler. B. Pulsed Wave Doppler showed venous blood flow in these vessels
- visualization of a twinkling artifact in focal adenomyomatosis of the gallbladder ( 1 , 26 ) (Fig. 4 B and Fig. Fig.6 6 );
- differentiation between a mass of biliary sludge and a solid tumor in the gallbladder ( 26 ) ;
- attempt to locate the site of gallbladder perforation ( 32 ) .
The issues presented in this paper are only a fraction of problems faced by an ultrasound operator in the field of gallbladder diagnostic imaging. However, the proposed ultrasound approaches should help solve some of these problems in everyday practice.
Conflict of interest
The authors do not report any financial or personal connections with other persons or organizations, which might negatively affect the contents of this publication and/or claim authorship rights to this publication.
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Gallbladder reporting and data system (GB-RADS) for risk stratification of gallbladder wall thickening on ultrasonography: an international expert consensus
- Published: 01 December 2021
- Volume 47 , pages 554–565, ( 2022 )
Cite this article
- Pankaj Gupta ORCID: orcid.org/0000-0003-3914-3757 1 ,
- Usha Dutta 2 ,
- Pratyaksha Rana 1 ,
- Manphool Singhal 1 ,
- Ajay Gulati 1 ,
- Naveen Kalra 1 ,
- Raghuraman Soundararajan 1 ,
- Daneshwari Kalage 1 ,
- Manika Chhabra 1 ,
- Vishal Sharma 2 ,
- Vikas Gupta 3 ,
- Thakur Deen Yadav 3 ,
- Lileshwar Kaman 4 ,
- Santosh Irrinki 4 ,
- Harjeet Singh 3 ,
- Yashwant Sakaray 4 ,
- Chandan Krishuna Das 5 ,
- Uma Saikia 6 ,
- Ritambhara Nada 6 ,
- Radhika Srinivasan 7 ,
- Manavjit Singh Sandhu 1 ,
- Raju Sharma 8 ,
- Nitin Shetty 9 ,
- Anu Eapen 10 ,
- Harmeet Kaur 11 ,
- Avinash Kambadakone 12 ,
- Robbert de Haas 13 ,
- Vinay K. Kapoor 14 ,
- Savio George Barreto 15 ,
- Atul K. Sharma 16 ,
- Amol Patel 17 ,
- Pramod Garg 18 ,
- Sujoy K. Pal 19 ,
- Mahesh Goel 20 ,
- Shraddha Patkar 20 ,
- Anu Behari 14 ,
- Anil K. Agarwal 21 ,
- Bhawna Sirohi 22 ,
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A Letter to the Editor to this article was published on 21 January 2023
The Gallbladder Reporting and Data System (GB-RADS) ultrasound (US) risk stratification is proposed to improve consistency in US interpretations, reporting, and assessment of risk of malignancy in gallbladder wall thickening in non-acute setting. It was developed based on a systematic review of the literature and the consensus of an international multidisciplinary committee comprising expert radiologists, gastroenterologists, gastrointestinal surgeons, surgical oncologists, medical oncologists, and pathologists using modified Delphi method. For risk stratification, the GB-RADS system recommends six categories (GB-RADS 0–5) of gallbladder wall thickening with gradually increasing risk of malignancy. GB-RADS is based on gallbladder wall features on US including symmetry and extent (focal vs. circumferential) of involvement, layered appearance, intramural features (including intramural cysts and echogenic foci), and interface with the liver. GB-RADS represents the first collaborative effort at risk stratifying the gallbladder wall thickening. This concept is in line with the other US-based risk stratification systems which have been shown to increase the accuracy of detection of malignant lesions and improve management.
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Abbreviations
Gallbladder reporting and data system
- Gallbladder cancer
Rokitansky-Aschoff sinuses
Common bile duct
Computed tomography
Magnetic resonance imaging
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Department of Radiodiagnosis and Imaging, Postgraduate Institute of Medical Education and Research, Chandigarh, India
Pankaj Gupta, Pratyaksha Rana, Manphool Singhal, Ajay Gulati, Naveen Kalra, Raghuraman Soundararajan, Daneshwari Kalage, Manika Chhabra & Manavjit Singh Sandhu
Department of Gastroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
Usha Dutta & Vishal Sharma
Department of Surgical Gastroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
Vikas Gupta, Thakur Deen Yadav & Harjeet Singh
Department of Surgery, Postgraduate Institute of Medical Education and Research, Chandigarh, India
Lileshwar Kaman, Santosh Irrinki & Yashwant Sakaray
Haematology and Medical Oncology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
Chandan Krishuna Das
Department of Histopathology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
Uma Saikia & Ritambhara Nada
Department of Cytology and Gynecological Pathology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
Radhika Srinivasan
Department of Radiology, All India Institute of Medical Education and Research, New Delhi, India
Raju Sharma
Department of Interventional Radiology, Tata Memorial Hospital, Mumbai, India
Nitin Shetty
Department of Radiodiagnosis, Christian Medical College, Vellore, India
Division of Diagnostic Imaging, Department of Abdominal Imaging, MD Anderson Cancer Centre, Houston, TX, USA
Harmeet Kaur
Abdominal Imaging, Harvard Medical School, Medical Director, Martha’s Vineyard Hospital Imaging, Massachusetts General Hospital, Boston, USA
Avinash Kambadakone
Radiology, University Medical Center Groningen, Groningen, The Netherlands
Robbert de Haas
HPB Surgery, Mahatma Gandhi Medical College & Hospital, Jaipur, India
Vinay K. Kapoor & Anu Behari
Division of Surgery and Perioperative Medicine, Flinders Medical Centre, Bedford Park, SA, Australia
Savio George Barreto
Department of Medical Oncology, All India Institute of Medical Sciences, New Delhi, India
Atul K. Sharma
Indian Naval Hospital Ship, Asvini, Mumbai, India
Department of Gastroenterology, All India Institute of Medical Sciences, New Delhi, India
Pramod Garg
Surgical Gastroenterology, All India Institute of Medical Sciences, New Delhi, India
Sujoy K. Pal
Gastrointestinal and HPB Surgery, Tata Memorial Hospital, Mumbai, India
Mahesh Goel & Shraddha Patkar
GI Surgery and Liver Transplant, GB Pant Institute of Medical Education and Research and MAM College, New Delhi, India
Anil K. Agarwal
Medical Oncology, Apollo Proton Cancer Centre, Chennai, India
Bhawna Sirohi
Department of Gastrointestinal Medical Oncology, MD Anderson Cancer Centre, Houston, USA
Milind Javle
HPB Surgery, University of Leicester, Leicester, UK
Giuseppe Garcea
Department of Gastroenterology, School of Medicine, Pontificia Universidad Catolica de Chile, Santiago, Chile
Flavio Nervi
Department of Pathology, Koc University Hospitals, Istanbul, Turkey
Volkan Adsay
Department of Pathology, Pontificia Universidad Catolica de Chile, Santiago, Chile
Juan Carlos Roa
Department of Surgery, College of Medicine, Seoul National University Bundang Hospital Seoul National University, Seongnam-si, South Korea
Ho-Seong Han
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PG, UD: Conceived and designed the work. PG, UD, PR, RS, DK, MC: Performed the systematic review of the literature. PG, UD, MS, NK, AG, VS, VG, TDY, CKD: Developed the first draft of survey statements. PG, UD, MS, AG, NK, VS, VG, TDY, LK, SI, HS, YS, CKD, US, RN, RS, MSS, RS, NS, AE, HK, AK, RdH, VKK, SGB, AKS, AP, PG, SKP, MG, SP, AB, AKG, BS, MJ, GG, FN, VA, JCR, HSH: Participated in the 1st, 2nd, and web-based rounds of the Delphi consensus and formulated the consensus statements. PG, UD, PR, RS, DK, MC: Wrote the initial draft. PG, UD, PR, MS, AG, NK, RS, DK, MC, VS, VG, TDY, LK, SI, HS, YS, CKD, US, RN, RS, MSS, RS, NS, AE, HK, AK, RdH, VKK, SGB, AKS, AP, PG, SKP, MG, SP, AB, AKG, BS, MJ, GG, FN, VA, JCR, HSH: Critically revised the manuscript, approved the final version of the manuscript submitted to the journal, and agree to be accountable for all aspects of the work.
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Gupta, P., Dutta, U., Rana, P. et al. Gallbladder reporting and data system (GB-RADS) for risk stratification of gallbladder wall thickening on ultrasonography: an international expert consensus. Abdom Radiol 47 , 554–565 (2022). https://doi.org/10.1007/s00261-021-03360-w
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Received : 28 October 2021
Revised : 16 November 2021
Accepted : 18 November 2021
Published : 01 December 2021
Issue Date : February 2022
DOI : https://doi.org/10.1007/s00261-021-03360-w
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Ultrasound Gallbladder sludge appears as a low amplitude homogeneous echoes, layering on the posterior wall, and frequently forming fluid-fluid level with anechoic bile above it. it moves slowly with changes in patient position sludge does not cause shadowing unless associated with gallstones 2
ultrasound The gallbladder is markedly distended (measuring up to 17cm) and contains a large volume of sludge and mobile gallstones. There is small volume pericholecystic free fluid. No gallbladder wall thickening. Sonographic Murphy's sign is however positive. Intrahepatic duct dilation is present. The common bile duct measures up to 6.4 mm.
Introduction There are several variations and etiologies of gallbladder disease. Chronic and acute cholecystitis are the two ways this condition can present. Calculous and acalculous (with or without gallstones or cholelithiasis) are also variants of this disease.
Learn what gallbladder sludge is, how it is seen on ultrasound, and what complications it can cause. Find out the predisposing factors, the different appearances of sludge, and how to diagnose and treat it.
Ultrasound (US) is the preferred initial modality in the investigation of right upper quadrant pain. It is more sensitive than HIDA scintigraphy 4 and CT in the diagnosis of acute cholecystitis, and more readily available. Ultrasound
What is cholecystitis? Cholecystitis (pronounced ko-luh-sis-TIE-tis) is a redness and swelling (inflammation) of the gallbladder. It happens when a digestive juice called bile gets trapped in your gallbladder. The gallbladder is a small organ under your liver. It stores bile which is made in the liver.
Ultrasonography is the method of choice for screening gallbladder (GB) disease, with a reported accuracy exceeding 90%. Bile is rendered echogenic by the presence of calcium bilirubinate and cholesterol crystals. [ 1]
Tumefactive sludge was identified according to the following US findings: (a) nonmovable mass-like lesion and (b) absence of posterior acoustic shadowing at B-mode US and vascularity at color Doppler US. Follow-up examinations were arranged to ascertain whether the results showed true sludge or gallbladder cancer.
Ultrasound of the gallbladder in sagittal (A) and transverse (B) projections in an 80-year-old male with right upper quadrant pain reveals a normal sized gallbladder with layering sludge (arrow). Some brighter non shadowing foci are appreciated in the sludge (arrowhead). One month after the ultrasound, the patient had a cholecystectomy.
Gallbladder sludge is a common diagnosis on routine abdominal sonography, yet its clinical importance is uncertain, especially in outpatients. To determine its natural history and potential future complications in this setting, we reviewed the imaging and clinical histories of nonhospitalized patients with a diagnosis of sludge on sonography ...
Intraluminal lesions of the gallbladder include gallstones, cholesterol polyps, adenomas, or sludge and polypoid type of gallbladder cancer must subsequently be excluded. Polyp size, stalk width, and enhancement intensity on contrast-enhanced ultrasound and degree of diffusion restriction may help differentiate cholesterol polyps and adenomas ...
Gallbladder sludge is a collection of cholesterol, calcium, bilirubin, and other compounds that build up in the gallbladder. It may indicate an underlying condition. Symptoms may include...
a Tomographic ultrasound images on B-mode with three-dimensional ultrasound reveals only biliary sludge in the gallbladder. Arrows show the margin of the sludge. b Contrast-enhanced ultrasound images can eliminate the background B-mode and reveal a hypervascular sessile polyp with an irregular vessel hidden by biliary sludge. Arrowheads show ...
Age: 75 years Gender: Male ultrasound Distended gall bladder containing echogenic, gravity dependent, mobile, biliary sludge with calculi. No specific features of cholecystitis ie no wall thickening or surrounding edema (nor pain on ultrasound probing of the fundus). 2 articles feature images from this case 10 public playlists include this case
Biliary sludge is a mixture of particulate solids that have precipitated from bile. Such sediment consists of cholesterol crystals, calcium bilirubinate pigment, and other calcium salts. Sludge is usually detected on transabdominal ultrasonography. Microscopy of aspirated bile and endoscopic ultrasonography are far more sensitive. Biliary sludge is associated with pregnancy; with rapid weight ...
Gallbladder polyps are protuberances of the gallbladder wall projecting into the lumen. They are usually incidentally found during abdominal sonography or diagnosed on histopathology of a surgery specimen, with an estimated prevalence of up to 9.5% of patients. Gallbladder polyps are not mobile and do not demonstrate posterior acoustic shadowing; they may be sessile or pedunculated ...
In an attempt to localise the source of pain, an ultrasound examination of the abdomen was performed, revealing a marked degree of gallbladder sludge. With appropriate medical management including ursodeoxycholic acid and insulin therapy, the patient stabilised and was discharged.
Outlook Biliary sludge can cause abdominal pain after eating along with other symptoms. Treatment can depend on the severity and may include treating the underlying cause, medications, or...
3. Ultrasound is more useful than CT and MRI for the initial evaluation of acute biliary disease. 4. CT is arguably the best technique for imaging of complicated gallbladder disease, particularly for direct imaging of emphysematous cholecystitis, gallstone ileus, and confirmation of suspected gallbladder perforation. 5.
Introduction. Gallbladder sludge (GBS) is defined as precipitated particulate matter dispersed in a viscous liquid phase within bile ().It is occasionally identified in cats during abdominal ultrasound examinations and appears sonographically as mobile echoes of variable amplitude without acoustic shadowing that tend to accumulate in the dependent portion of the gallbladder (Figure 1).
The recent developments in benign diseases of the gallbladder are discussed and illustrated. Acute cholecystitis (AC) is the most common benign gallbladder disease and thus it will be our main focus. We will provide and update on the imaging, clinical, and treatment of AC which have been reported in the last 10 years.
The posterior wall of the gallbladder closely adheres to the duodenal bulb, which is filled with liquid in this case. The image may be unclear due to the presence of gas generating reflections in the gallbladder, which mimic biliary sludge. This acoustic effect also blurs the outline of the gallbladder wall in this region.
The Gallbladder Reporting and Data System (GB-RADS) ultrasound (US) risk stratification is proposed to improve consistency in US interpretations, reporting, and assessment of risk of malignancy in gallbladder wall thickening in non-acute setting. It was developed based on a systematic review of the literature and the consensus of an international multidisciplinary committee comprising expert ...