Diagnostic ultrasound ( PDFDrive )

CHAPTER
6
The Biliary Tree and Gallbladder
Korosh Khalili and Stephanie R. Wilson
SUMMARY OF KEY POINTS
• Ultrasound should be the irst imaging modality used in
the evaluation of the patients with potential disease of the
biliary tree.
• Awareness of various scanning techniques and use of
harmonic and compound imaging improve visualization of
various diseases affecting the biliary tree.
• Stones in the intrahepatic and extrahepatic biliary tree can
be easily overlooked; familiarity with their appearance and
a high index of suspicious improve their detection.
• Cholecystitis is a common disease with variable degrees
of severity. A high index of suspicion and sensitivity,
particularly to distention and hyperemia of the gallbladder,
allows for improved detection.
• The clinical presentation of the patient, particularly pain
and signs of inlammation, helps in differentiating the
common inlammatory conditions of the biliary tree and
gallbladder from the rarer malignancies which they may
mimic.
CHAPTER OUTLINE
THE BILIARY TREE
Anatomy and Normal Variants
Sonographic Technique
Choledochal Cysts
Caroli Disease
Overview of Biliary Tree Obstruction
Choledocholithiasis
Intrahepatic Stones
Common Bile Duct Stones
Mirizzi Syndrome
Hemobilia
Pneumobilia
Biliary Tree Infection
Acute (Bacterial, Ascending)
Cholangitis
Liver Flukes
Recurrent Pyogenic Cholangitis
Ascariasis
HIV Cholangiopathy
Immune-Related Diseases of the Biliary
Tree
Primary Biliary Cirrhosis and
Autoimmune Cholangitis
Primary Sclerosing Cholangitis
IgG4-Related Cholangitis
Cholangiocarcinoma
Intrahepatic Cholangiocarcinoma
Hilar Cholangiocarcinoma
Distal Cholangiocarcinoma
Metastases to Biliary Tree
THE GALLBLADDER
Anatomy and Normal Variants
Sonographic Technique
Gallstone Disease
Biliary Sludge
Acute Cholecystitis
Gangrenous Cholecystitis
Perforated Gallbladder
Emphysematous Cholecystitis
Acalculous Cholecystitis
Torsion (Volvulus) of Gallbladder
Chronic Cholecystitis
Porcelain Gallbladder
Adenomyomatosis (Adenomatous
Hyperplasia)
Polypoid Masses of Gallbladder
Cholesterol Polyps
Adenomas, Adenomyomas, and
Inlammatory Polyps
Malignancies
Gallbladder Carcinoma
Patterns of Tumor Spread
Sonographic Appearance
Sonographic evaluation of the biliary tract is one of the most
appropriate and eicacious uses of the ultrasound examination.
he cystic nature of both the gallbladder and the bile ducts,
particularly when dilated, provides an inherently high-contrast
resolution in comparison to the adjacent tissues. he excellent
spatial resolution of sonography, and the acoustic window
provided by the liver allow for a high-quality examination in
most patients. Currently, sonography remains the imaging
modality of choice for the detection of gallstones, assessment of
acute right upper quadrant (RUQ) pain, and initial evaluation
of the patient with jaundice or elevated liver function tests. In
conjunction with magnetic resonance imaging (MRI), magnetic
resonance cholangiopanreatography (MRCP), and contrastenhanced
computed tomography (CT), sonography also plays
a key role in the multimodality evaluation of more complex
biliary problems, such as the diagnosis and staging of hilar
cholangiocarcinoma. he recent development of contrastenhanced
sonography for detection of hepatic masses further
broadens this role. From the smallest ultrasound departments
operating in remote geographic areas to the largest tertiary
institutions, no other anatomic location in the body is better
studied with sonography than the biliary tract.
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