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PATHOLOGY OF THE GALLBLADDER AND BILIARY TREE 55
Doppler, does enable the operator to demonstrate
vascularity in the normal gallbladder wall and the
operator should be familiar with normal appearances
for the machine in use when making the
diagnosis of acute cholecystitis 14 (Fig. 3.24).
Doppler can potentially distinguish acute inflammation
from chronic disease. 15 However, falsepositive
results can be found in cases of pancreatitis
and gallbladder carcinoma and the technique does
not add significantly to the grey-scale image.
Complications may occur if the acute inflammation
progresses (see below) due to infection,
pericholecystic abscesses and peritonitis.
Further management of acute cholecystitis
In an uncomplicated acute cholecystitis, analgesia
to settle the patient in the short term is followed
by the removal of the gallbladder. Open surgery,
which is increasingly reserved for the more
A
B
C
D
Figure 3.22 Acute cholecystitis: (A) TS of an oedematous, thickened gallbladder wall with a stone. (B) LS with a
thickened wall (arrows). Stones and debris are present. (C) and (D) TS and LS demonstrating pericholecystic fluid.
(Continued)