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PATHOLOGY OF THE GALLBLADDER AND BILIARY TREE 59
A
B
Figure 3.26 (A) Acalculous cholecystitis. The gallbladder wall is markedly thickened and tender on scanning.
(B) Gravity-dependent sludge with a thick, oedematous wall. No stones were present.
Figure 3.27 Acute on chronic cholecystitis. A patient
with known gallstones and chronic cholecystitis presents
with an episode of acute gallbladder pain. The wall is
considerably more thickened and hyperechoic than on
previous scans.
ing which parts of the biliary tree are dilated (Fig.
3.32):
●
Dilatation of the common bile duct (that is,
that portion of the duct below the cystic duct
insertion) implies obstruction at its lower end.
Figure 3.28 Gangrenous cholecystitis. The gallbladder
wall is focally thickened and an intramural abscess has
formed on the anterior aspect.
●
Dilatation of both biliary and pancreatic ducts
implies obstruction distally, at the head of the
pancreas or ampulla of Vater. This is more
likely to be due to carcinoma of the head of
pancreas, ampulla or acute pancreatitis than a
stone. However, it is possible for a stone to be