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PATHOLOGY OF THE GALLBLADDER AND BILIARY TREE 51 A Figure 3.16 (A) The gallbladder lumen is filled with stones, causing dense shadowing in the gallbladder fossa. The thickened gallbladder wall can be demonstrated separately (arrows) from the reflective surface of the stones. (B) A small layer of bile is visible between the stones and the anterior gallbladder wall. B Figure 3.17 Microgallbladder in cystic fibrosis. Figure 3.18 TS of a porcelain gallbladder demonstrating a calcified wall with strong acoustic shadowing. HYPERPLASTIC CONDITIONS OF THE GALLBLADDER WALL Adenomyomatosis This is a non-inflammatory, hyperplastic condition which causes gallbladder wall thickening. It may be mistaken for chronic cholecystitis on ultrasound. The epithelium which lines the gallbladder wall undergoes hyperplastic change, extending diverticula into the adjacent muscular layer of the wall. These diverticula, or sinuses (known as Rokitansky–Aschoff sinuses), are visible within the wall as fluid-filled spaces (Fig. 3.19), which can bulge eccentrically into the lumen, and may contain echogenic material or even (normally pigment) stones. The wall thickening may be focal or diffuse, and the sinuses may be little more than hypoechoic
52 ABDOMINAL ULTRASOUND ‘spots’ in the thickened wall, or may become quite large cavities in some cases. 9 Deposits of crystals in the gallbladder wall frequently result in distinctive ‘comet-tail’ artefacts. Often asymptomatic, this may present with biliary colic although it is unclear whether this is caused by co-existent stones. Its distinctive appearance allows the diagnosis to be made easily, whether or not stones are present. Cholecystectomy is performed in symptomatic patients, usually those who also have stones. Although essentially a benign condition, a few cases of associated malignant transformation have been reported, usually in patients with asso- A B C Figure 3.19 Adenomyomatosis: (A) LS demonstrating a thickened gallbladder wall with a small Rokitansky-Aschoff sinus (arrow) at the fundus. (B) TS demonstrating a stone and comet-tail artifacts from within the wall due to crystal deposits. (C) TS through a more advanced case of adenomyomatosis with a large Rokitansky–Aschoff sinus, giving the appearance of a ‘double lumen’.
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Abdominal Ultrasound
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Abdominal Ultrasound How, Why and W
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v Contents Contributors Preface ix
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vii Contributors Rosemary Arthur FR
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ix Preface Ultrasound continues to
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ABBREVIATIONS xi MHA MHV MI MPV MRA
Page 14 and 15: Chapter 1 1 Optimizing the diagnost
Page 16 and 17: OPTIMIZING THE DIAGNOSTIC INFORMATI
Page 30 and 31: Chapter 2 17 The normal hepatobilia
Page 32 and 33: THE NORMAL HEPATOBILIARY SYSTEM 19
Page 54 and 55: Chapter 3 41 Pathology of the gallb
Page 56 and 57: PATHOLOGY OF THE GALLBLADDER AND BI
Page 92 and 93: Chapter 4 79 Pathology of the liver
Page 94 and 95: PATHOLOGY OF THE LIVER AND PORTAL V
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PATHOLOGY OF THE LIVER AND PORTAL V
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Chapter 5 121 The pancreas CHAPTER
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THE PANCREAS 123 the patient’s le
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THE PANCREAS 125 Acute pancreatitis
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THE PANCREAS 127 E F G Figure 5.3 c
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A C DISTANCE = 3.43 CM 5%. 13 Over
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THE PANCREAS 131 G H I Figure 5.5 c
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THE PANCREAS 133 head of pancreas.
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THE PANCREAS 135 pancreatic juice i
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Chapter 6 137 The spleen and lympha
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THE SPLEEN AND LYMPHATIC SYSTEM 139
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Chapter 7 153 The renal tract CHAPT
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THE RENAL TRACT 155 As with any oth
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THE RENAL TRACT 157 A B q 0 LRA AO
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THE RENAL TRACT 159 junctions of or
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THE RENAL TRACT 161 A B Figure 7.5
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THE RENAL TRACT 163 carcinomas, the
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THE RENAL TRACT 165 the vesicourete
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THE RENAL TRACT 167 Table 7.1 Sourc
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THE RENAL TRACT 169 A B Figure 7.13
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THE RENAL TRACT 171 Table 7.2 Diffe
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THE RENAL TRACT 173 Ultrasound stil
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THE RENAL TRACT 175 CT is useful fo
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THE RENAL TRACT 177 Xanthogranuloma
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THE RENAL TRACT 179 As with acute t
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THE RENAL TRACT 181 der with increa
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THE RENAL TRACT 183 ● ● Morphol
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THE RENAL TRACT 185 ● ● hydrone
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THE RENAL TRACT 187 A Figure 7.27 A
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THE RENAL TRACT 189 vascular reject
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THE RENAL TRACT 191 B A C Figure 7.
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THE RENAL TRACT 193 computerised ul
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Chapter 8 195 The retroperitoneum a
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THE RETROPERITONEUM AND GASTROINTES
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Chapter 9 215 The paediatric abdome
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THE PAEDIATRIC ABDOMEN 217 A B SPLE
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THE PAEDIATRIC ABDOMEN 219 B A B Fi
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THE PAEDIATRIC ABDOMEN 221 probe de
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THE PAEDIATRIC ABDOMEN 223 When the
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THE PAEDIATRIC ABDOMEN 225 + 78 A 2
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THE PAEDIATRIC ABDOMEN 227 A B C D
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THE PAEDIATRIC ABDOMEN 229 Table 9.
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THE PAEDIATRIC ABDOMEN 231 A LT B C
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THE PAEDIATRIC ABDOMEN 237 mesenter
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THE PAEDIATRIC ABDOMEN 239 E F G Fi
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THE PAEDIATRIC ABDOMEN 241 system i
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Chapter 10 The acute abdomen 243 CH
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THE ACUTE ABDOMEN 245 scan of the p
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THE ACUTE ABDOMEN 247 LIVER LS GB S
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THE ACUTE ABDOMEN 249 D A RT B C E
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THE ACUTE ABDOMEN 251 17. Patlas M,
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Chapter 11 253 Interventional and o
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INTERVENTIONAL AND OTHER TECHNIQUES
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275 Bibliography and further readin
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277 Index A Abdomen, acute gastroin
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INDEX 279 Continuous ambulatory per
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INDEX 281 Intravenous urography (IV
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INDEX 283 Phrygian cap, 29 Pneumobi
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