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US and CT Correlation in Evaluation of Various Gallbladder Diseases
Abstracts cholecystitis, hemobilia with small papillary adenocarcinoma, large undifferentiated carcinoma and pneumobilia from cholecystoduodenal fistula were illustrated. The clues for differential diagnosis of echogenic lesions replacing the gallbladder lumen were discussed. Conclusion: Echogenic lesions replace gallbladder lumen due to various causes and radiologic findings. This exhibit will help make the differential diagnosis of echogenic lesion replacing the gallbladder lumen.
P 039 se Segmental Chronic Cholecystitis with Stones: Sonographic Findings and Manifestations T. Wang,1 C. W. Chang,2 C. Liu,1 H. Wang,1 S. Shih2 1 Hepato-gastroenterology, Mackay Memorial Hospital, Taipei/TW, 2 Gastroenterology, Mackay Memorial Hospital, Taipei/TW Purpose: There is a wide variation in gallbladder (GB) configuration. A dumbbell or Phrygian cap deformity of the gallbladder can occur in about 1-4% of general population. Stones in this deformity fundus of GB may cause focal inflammation and easily to be overlooked in sonography. Material & Methods: We reviewed the clinical manifestations and sonography of 13 patients in our institute. Results: From Aug 2008 to Jan 2011, 5 male and 8 female met the criteria of segmental cholecystitis with GB stones. The mean average age was 51.569.9 years. All cases showed the portion of GB fundus to be markedly thickened and stones in GB. Four patients had wellknown litholithiasis for years. Eight of 13 patients had symptomatic history, such as RUQ pain and dyspepsia. Three had acute cholecystitis episode, and one patient received surgical cholecystectomy. Previous US overlooked the SCC in three patients due to bowel gas and consolidation of focal inflammation and collapsed of GB. Conclusion: Segmental cholecystitis with stones was rarely mentioned before. It is one of the variations of chronic cholecystitis and has no other medical implications. However, deformity GB with focal inflammation and stones may be mistaken in the clinical practice, especially in the case of a lot of intestinal gas.
P 040 se Sonography of Acute Cholecystitis: Murphy’s Sign or Murphy’s Law? A. C. Friedman,1 P. Mukerji,2 A. Buadu,2 C. Grandone2 1 Radiology, University of Arizona, Tucson/US, 2University of Arizona, Tucson/AZ/US Purpose: We noticed false positive and false negative errors in the sonographic diagnosis of acute cholecystitis due to a reliance on the ultrasound technologists’ assessment of the sonographic Murphy’s sign. We added color and/or power Doppler to gallbladder ultrasound to try to improve. Material & Methods: We reviewed difficult cases of suspected acute cholecystitis after the addition of Doppler to the exam protocol. Results: There were 5 false (-) Murphy’s, 3 of which were true (+) on Doppler. One (gangrenous cholecystitis) had no Doppler done. There were 2 false (+) Murphy’s, both were true (-) on Doppler. There was 1 false (+) Doppler with a negative Murphy’s. There were 10 additional true (-) Dopplers in patients with thick-walled gallbladders. Conclusion: Doppler of the gallbladder for acute cholecystitis was studied 10-15 years ago and opinions varied from very useful through useful adjunct to gray scale to not helpful. In the interim equipment has improved and our practice has changed in that most patients are not scanned by a physician. Doppler sonography can be documented pictorially and reviewed by the attending, whereas Murphy’s sign cannot. We believe it is a better adjunct to gray-scale findings than Murphy’s sign.
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P 041 ee US and CT Correlation in Evaluation of Various Gallbladder Diseases Y. H. Lee, S. W. Lim, M. S. Kim Radiology, Wonkwang University Hospital, Iksan/KR Learning Objectives: 1. To review the US and CT findings in various acute or chronic gallbladder diseases. 2. To know the advantages and disadvantages of ultrasound examination compared to CT in the evaluation of gallbladder diseases. Background: MDCT became a diagnostic hallmark of abdominal diseases; however, in some cases of gallbladder diseases, it is difficult to make a correct diagnosis by MDCT alone. For example, it is difficult to make a correct diagnosis of hyperplastic cholecystoses by MDCT. The ultrasonographic features of cholesterolosis and adenomyomatosis of the gallbladder are well known; however, the US and CT findings do not correlate well. Imaging Findings or Procedure Details: We analyzed the US findings of various acute and chronic diseases involving the gallbladder in patients who were confirmed by histopathology in our Hospital. We compared the high-resolution US findings with the MDCT findings. In this exhibit, we will review the US and CT findings of acute gallbladder diseases, such as acute cholecystitis, perforation of the gallbladder and chronic diseases including chronic cholecystitis, xanthogranulomatous cholecystitis, hyperplastic cholecystoses and benign or malignant gallbladder tumors. Conclusion: In some cases, US provides more helpful clues for correct diagnosis of gallbladder (GB) lesions than CT, especially in the detection of some stones or polyps. On the other hand, in some cases such as wall thickening in a type of GB cancer or identifying lymphadenopathy, CT was superior to US. So, we believe that sonography and CT are complementary examinations in the evaluation of GB lesions.
P 042 ee Pitfalls in the Ultrasonography of the Gallbladder: Enigma, Ambiguity and Conquest H. J. Kim, K. W. Kim, J. H. Byun, S. S. Lee, M. Lee Radiology, Asan Medical Center, Seoul/KR Learning Objectives: 1. To explain the pitfalls in the ultrasonography of the gallbladder. 2. To know the methods to overcome the pitfalls in the ultrasonography of the gallbladder. Background: Ultrasonography is the method of choice of screening for gallbladder disease. The diagnostic accuracy of ultrasonography for gallbladder disease is high, however, false-positive and false-negative diagnoses are not rare in daily practice. This exhibition will present the myriad of problems encountered at ultrasonographic examination of the gallbladder and show the pitfalls and problems, which we have experienced. Finally, we will suggest methods to overcome these pitfalls. Imaging Findings or Procedure Details: This exhibition will be presented as a quiz format. Mimickers of gallbladder stones: calcium bile salt precipitates and sludge ball versus soft pigment stone. Mimickers of wall-echo shadow complex: emphysematous cholecystitis and porcelain gallbladder. Mimickers of acalculous cholecystitis: cystic duct cancer and sepsis. Non-shadowing intraluminal echoes: gallbladder sludge versus gallbladder cancer, and clonorchiasis versus cholesterol crystal. Gallbladder hemorrhage: gallbladder cancer, hemorrhagic cholecystitis, coagulopathy and trauma. Diffuse gallbladder wall thickening: acute hepatitis, pancreatitis, congestive heart failure, chronic renal failure and sepsis. Intramural hypoechoic nodules: adenomyomatosis, gangrenous cholecystitis and xanthogranulomatous cholecystitis. Intramural hyperechoic nodules: emphysematous cholecystitis, cholesterol polyp and adenomyomatosis.
P 039 se Segmental Chronic Cholecystitis with Stones: Sonographic Findings and Manifestations T. Wang,1 C. W. Chang,2 C. Liu,1 H. Wang,1 S. Shih2 1 Hepato-gastroenterology, Mackay Memorial Hospital, Taipei/TW, 2 Gastroenterology, Mackay Memorial Hospital, Taipei/TW Purpose: There is a wide variation in gallbladder (GB) configuration. A dumbbell or Phrygian cap deformity of the gallbladder can occur in about 1-4% of general population. Stones in this deformity fundus of GB may cause focal inflammation and easily to be overlooked in sonography. Material & Methods: We reviewed the clinical manifestations and sonography of 13 patients in our institute. Results: From Aug 2008 to Jan 2011, 5 male and 8 female met the criteria of segmental cholecystitis with GB stones. The mean average age was 51.569.9 years. All cases showed the portion of GB fundus to be markedly thickened and stones in GB. Four patients had wellknown litholithiasis for years. Eight of 13 patients had symptomatic history, such as RUQ pain and dyspepsia. Three had acute cholecystitis episode, and one patient received surgical cholecystectomy. Previous US overlooked the SCC in three patients due to bowel gas and consolidation of focal inflammation and collapsed of GB. Conclusion: Segmental cholecystitis with stones was rarely mentioned before. It is one of the variations of chronic cholecystitis and has no other medical implications. However, deformity GB with focal inflammation and stones may be mistaken in the clinical practice, especially in the case of a lot of intestinal gas.
P 040 se Sonography of Acute Cholecystitis: Murphy’s Sign or Murphy’s Law? A. C. Friedman,1 P. Mukerji,2 A. Buadu,2 C. Grandone2 1 Radiology, University of Arizona, Tucson/US, 2University of Arizona, Tucson/AZ/US Purpose: We noticed false positive and false negative errors in the sonographic diagnosis of acute cholecystitis due to a reliance on the ultrasound technologists’ assessment of the sonographic Murphy’s sign. We added color and/or power Doppler to gallbladder ultrasound to try to improve. Material & Methods: We reviewed difficult cases of suspected acute cholecystitis after the addition of Doppler to the exam protocol. Results: There were 5 false (-) Murphy’s, 3 of which were true (+) on Doppler. One (gangrenous cholecystitis) had no Doppler done. There were 2 false (+) Murphy’s, both were true (-) on Doppler. There was 1 false (+) Doppler with a negative Murphy’s. There were 10 additional true (-) Dopplers in patients with thick-walled gallbladders. Conclusion: Doppler of the gallbladder for acute cholecystitis was studied 10-15 years ago and opinions varied from very useful through useful adjunct to gray scale to not helpful. In the interim equipment has improved and our practice has changed in that most patients are not scanned by a physician. Doppler sonography can be documented pictorially and reviewed by the attending, whereas Murphy’s sign cannot. We believe it is a better adjunct to gray-scale findings than Murphy’s sign.
S87
P 041 ee US and CT Correlation in Evaluation of Various Gallbladder Diseases Y. H. Lee, S. W. Lim, M. S. Kim Radiology, Wonkwang University Hospital, Iksan/KR Learning Objectives: 1. To review the US and CT findings in various acute or chronic gallbladder diseases. 2. To know the advantages and disadvantages of ultrasound examination compared to CT in the evaluation of gallbladder diseases. Background: MDCT became a diagnostic hallmark of abdominal diseases; however, in some cases of gallbladder diseases, it is difficult to make a correct diagnosis by MDCT alone. For example, it is difficult to make a correct diagnosis of hyperplastic cholecystoses by MDCT. The ultrasonographic features of cholesterolosis and adenomyomatosis of the gallbladder are well known; however, the US and CT findings do not correlate well. Imaging Findings or Procedure Details: We analyzed the US findings of various acute and chronic diseases involving the gallbladder in patients who were confirmed by histopathology in our Hospital. We compared the high-resolution US findings with the MDCT findings. In this exhibit, we will review the US and CT findings of acute gallbladder diseases, such as acute cholecystitis, perforation of the gallbladder and chronic diseases including chronic cholecystitis, xanthogranulomatous cholecystitis, hyperplastic cholecystoses and benign or malignant gallbladder tumors. Conclusion: In some cases, US provides more helpful clues for correct diagnosis of gallbladder (GB) lesions than CT, especially in the detection of some stones or polyps. On the other hand, in some cases such as wall thickening in a type of GB cancer or identifying lymphadenopathy, CT was superior to US. So, we believe that sonography and CT are complementary examinations in the evaluation of GB lesions.
P 042 ee Pitfalls in the Ultrasonography of the Gallbladder: Enigma, Ambiguity and Conquest H. J. Kim, K. W. Kim, J. H. Byun, S. S. Lee, M. Lee Radiology, Asan Medical Center, Seoul/KR Learning Objectives: 1. To explain the pitfalls in the ultrasonography of the gallbladder. 2. To know the methods to overcome the pitfalls in the ultrasonography of the gallbladder. Background: Ultrasonography is the method of choice of screening for gallbladder disease. The diagnostic accuracy of ultrasonography for gallbladder disease is high, however, false-positive and false-negative diagnoses are not rare in daily practice. This exhibition will present the myriad of problems encountered at ultrasonographic examination of the gallbladder and show the pitfalls and problems, which we have experienced. Finally, we will suggest methods to overcome these pitfalls. Imaging Findings or Procedure Details: This exhibition will be presented as a quiz format. Mimickers of gallbladder stones: calcium bile salt precipitates and sludge ball versus soft pigment stone. Mimickers of wall-echo shadow complex: emphysematous cholecystitis and porcelain gallbladder. Mimickers of acalculous cholecystitis: cystic duct cancer and sepsis. Non-shadowing intraluminal echoes: gallbladder sludge versus gallbladder cancer, and clonorchiasis versus cholesterol crystal. Gallbladder hemorrhage: gallbladder cancer, hemorrhagic cholecystitis, coagulopathy and trauma. Diffuse gallbladder wall thickening: acute hepatitis, pancreatitis, congestive heart failure, chronic renal failure and sepsis. Intramural hypoechoic nodules: adenomyomatosis, gangrenous cholecystitis and xanthogranulomatous cholecystitis. Intramural hyperechoic nodules: emphysematous cholecystitis, cholesterol polyp and adenomyomatosis.