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cholelithiasis _gall stone_

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					CHOLELITHIASIS (GALL STONE)

Highly echo reflective originating from anterior surface of the calculus with
prominent posterior acoustic shadow.
Multiple small stones show echogenic foci with nonshadowing.
Sludge balls (tumefactive biliary sludge) can appear as mobile masses within
gallbladder lumen without posterior acoustic shadowing. Material includes
parasites; blood clots aggregated pus, sludge and contrast material.
Wall-echo-shadow (WES triad) or the double arc shadow sign: two parallel,
curved, echogenic lines separated by a thin anechoic space with distal acoustic
shadowing.

ACUTE CHOLECYSTITIS

Primary signs:     gall stones, focally tender gall bladder (sonographic
                   Murphy’s sign) and impacted gall stone.
Secondary signs: gall bladder dilatation, sludge and diffuse wall thickening
                   (>3mm).
Doppler shows increased color flow in the gall bladder wall.

Emphysematous cholecystitis- diabetic, M: F= 7:3
If gas is intraluminal, image consists of prominent nondependent hyperechoic
focus with an associated ring down or comet-tail artifact.
Intramural gas has a semicircular or arc-like configuration.
Large gas is present; appearance may simulate calcification in the gall bladder
wall or gallbladder filled with stones.
Gangrenous cholecystitis
Marked irregularity or asymmetric thickening of gall bladder wall with multiple
striations due to ulceration, hemorrhage, necrosis and microabscesses.
Gall bladder perforation
Acute, resulting in generalized peritonitis.
Subacute, resulting in a pericholecystic abscess-complex echogenic
pericholecystic fluid collection with septations, or encompass gall bladder
resulting nonvisible gall bladder. Thick, hypoechoic gall bladder wall and
cholelithiasis color Doppler shows acute pericholecystic inflammation by
demonstrating an echogenic pericholecystic mass contains internal vascularity.
Chronic, resulting in an internal biliary fistula.

ACACULOUS CHOLECYSTITIS
Gall bladder wall thickening (in the absence of hypoalbuminemia, ascites,
congestive heart failure), pericholecystic fluid or subserosal edema, intraluminal
or intramural gas, or sloughed mucosal membranes.

CHRONIC CHOLECYSTITIS
Gall bladder wall thickening, contracted gall bladder after nil by mouth (2days)
with or without multiple small stones
SLUDGE
Low to mid-level echoes.

PERICHOLECYSTIC FLUID
Anechoic or complex fluid collection adjacent to or surrounding the gall bladder.

WALL CHANGES
Diffuse wall thickening: relatively hypoechoic region between two echogenic
lines. Thickened wall may have striated or layered appearance.
Causes: acute cholecystitis, hepatic dysfunction (associated with alcoholism,
hypoalbuminemia, ascites, and hepatitis), congestive heart failure, renal disease,
AIDS, and sepsis.
Unusual leukemic infiltration, interleukin 2 chemotherapy and gall bladder
varices.
Focal wall thickening suggests primary gall bladder disease.
Causes: gall bladder carcinoma, metastatic nodules, polyps, papillary
adenomas, adenomyomatosis and tumefactive sludge.

GALL BLADDER POLYPS (ADENOMATOUS AND CHOLESTEROL)

Cholesterol polyps show aggregation of echogenic spots.
Adenomyomatosis show echogenic or anechoic foci visible within thickened gall
bladder wall.

GALL BLADDER CARCINOMA

Intraluminal mass, asymmetric wall thickening, mass replacing the gall bladder,
gall bladder wall calcification, cholelithiasis, liver metastases, adenopathy, and
bile duct dilatation.

GALL BLADDER METASTASIS

Small area of wall irregularity is present with wide base of mass due to
melanoma, GI cancer, breast cancer, carcinoid tumor and lymphoma.

HEMOBILIA
Heterogeneously echogenic material almost completely fills the gall bladder
lumen.

MILK OF CALCIUM BILE OR LIMLY BILE
Both an echogenic flat fluid-fluid level and convex shadowing meniscus pattern.

PARASITIC INFESTATION
Nonshadowing intracystic wormlike structure may be mobile which is linear ( 4 to
7 cm) or coiled.
INTRAHEPATIC BILIARY CALCULI
This condition a variety of names, including Oriental cholangiohepatitis,
intrahepatic pigment stone disease, and biliary obstruction syndrome of
the Chinese.
It occurs with recurrent pyogenic cholangitis (RPC).
Moderate echogenicity and lack acoustic shadowing.

SCLEROSING AND AIDS CHOLANGITIS
Minimal luminal bile duct dilatation.
Smooth or irregular wall thickening of the intrahepatic bile ducts.

CYSTADENOMA (BENIGN) – middle aged women
Cystic masses with multiple septae and papillary excrescences may be
unilocular, calcified or multiple.

CYSTADENOCARCINOMA (MALIGNANT)
Cystic masses with multiple septae and papillary excrescences may be
unilocular, calcified or multiple.

				
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