#45 - Gallbladder Pathology by Ultrasound

Match the following 5 images with their corresponding pathologies: 

Image 1

Image 1

Image 2

Image 2

Image 3

Image 3

Image 4

Image 4

Image 5

Image 5

a) normal

b) stone

c) sludge

d) diverticula

e) polyps 

Answers: 

Image 1 - polyps

-        Elevated lesions on mucosal surface – usually benign

-        Polypoid ingrowth into gallbladder lumen

-        Small polyps are echongenic but non shadowing and can be adherent to the wall

-        Larger cholesterol polyps tend to be hypoechoi

Image 2 - sludge

-        Biliary sand, biliary sediment or thick bile

-        See liquid - liquid level in the gallbladder

-        Low amplitude homogenous echoes

-        No shadowing

Image 3 - normal

Image 4 - stone

-        See highly reflective echogenic focus inside gallbladder lumen

-        See posterior acoustic shadowing of the stone

-        Can see gravity dependent movement with change in patient position

-        Color doppler may show a twinkle artifact which is helpful for small stones

Image 5 - diverticula

-        Common and benign cause of focal gallbladder wall thickening

-        Intramural mucosal diverticula – penetrates muscle wall of gallbladder

-        Can see normal wall thickness or Mural thickening – diffuse, focal or annular

-        Comment tail artifact – form of a reverberation artifact, which are due to the cholesterol crystals