Diagnostic ultrasound ( PDFDrive )

CHAPTER 6 The Biliary Tree and Gallbladder 201
A
B
C
D
E
F
G
H
I
FIG. 6.42 Sympathetic Thickening of the Gallbladder Wall in Three Patients With Positive Sonographic Murphy Sign. (A)-(C) Acute
hepatitis. (A) and (B) Views of the gallbladder show marked circumferential thickening of the gallbladder wall. The lumen is not distended. (C)
Left lobe of the liver shows periportal cufing. (D)-(F) Perforation of a duodenal ulcer. (D) and (E) Asymmetrical, marked thickening of the gallbladder
wall. (F) Free intraperitoneal air. The peritoneal line in the epigastrium (arrow) marks a linear area of increased echogenicity with posterior dirty
shadowing. (G)-(I) Acute pyelonephritis. (G) and (H) Asymmetrical thickening of the gallbladder wall. (I) CT scan shows striated nephrogram
(arrow). (D-F courtesy of Dr. A.E. Hanbidge, University of Toronto.)
Torsion (Volvulus) of Gallbladder
Gallbladder torsion is a rare, acute entity. Patients have symptoms
of acute cholecystitis. Volvulus is oten seen in older women and
may be related to a mobile gallbladder with a long suspensory
mesentery. he hallmarks on imaging are a massively distended
and inlamed gallbladder lying in an unusual horizontal position,
with its long axis oriented in a let-to-right direction. A twist of
the cystic artery and cystic duct may be visible. If the torsion is
greater than 180 degrees, gangrene of the gallbladder ensues;
otherwise, obstruction of the cystic duct and acute cholecystitis
occur. In either case, treatment is usually surgical. 92
Chronic Cholecystitis
Chronic cholecystitis is associated with the mere presence of
gallstones; therefore patients are usually asymptomatic and have
mild disease. Chronic cholecystitis has the same incidence and
risk factors as gallstone disease. More advanced cases involve
wall thickening and ibrosis, appearing on sonographic