Radiology Notes

My notes during radiology residency, fellowship, and beyond…

Archive for the ‘gallbladder’ Category

Gallstone Ileus

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  • erosion of gallstone through GB wall into GI tract
  • fistula between GB and duodenum (stomach, colon)
  • large stones impact in ileum = mechanical SBO
  • Bouveret’s Syndrome = gastric outlet obstruction due to impaction of a stone
  • XR findings = Rigler’s triad
    • pneumobilia
    • dilated SB
    • ectopic calcified gallstone
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Written by lmwong

January 11, 2010 at 11:17 pm

Posted in abdomen, gallbladder, gi, Phalen

Acalculous Cholecystitis CT criteria

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2 major or 1 major + 2 minor

Major criteria:

  • Gallbladder wall thickening greater than 3 mm
  • Subserosal halo (ie, gallbladder wall edema)
  • Pericholecystic fatty inflammation
  • Pericholecystic fluid (without ascites or hypoalbuminemia)
  • Mucosal sloughing
  • Intramural gas

Minor criteria:

  • Gallbladder distention (>5 cm transverse)
  • High-attenuation bile (sludge)

Written by lmwong

December 19, 2009 at 2:18 am

Posted in abdomen, ct, gallbladder, gi

Porcelain Gallbladder

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  • calcification of gallbladder wall
  • associated with chronic inflammation, 95% have gallstones
  • up to 61% risk of malignancy, needs prophylactic cholecystectomy

Written by lmwong

June 6, 2008 at 5:45 pm

Adenomyomatosis of gallbladder

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  • mucosal hyperplasia and thickening of muscular layer
  • Rokitansky-Aschoff sinuses = mucosal herniation through muscle layer, contain cholesterol crystals
  • U/S: bright reflections with comet-tail artifacts

Written by lmwong

June 6, 2008 at 5:38 pm

Gallbladder polyps

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  • less than 5mm or 5-10mm in size, nonmobile, no shadow
  • most common polyp is a cholesterol polyp
  • others: adenomas, papillomas, leiomyomas, lipomas, neuromas
  • metastatic melanoma produces gallbladder polyps
  • 5-10mm polyps require folllow up.

Written by lmwong

June 6, 2008 at 5:32 pm

Gallbladder Wall Thickening

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  • Cholecystitis: acute, chronic, acalculus, xanthogranulomatous
  • Gallbladder carcinoma
  • Adenomyomatosis
  • Liver cirrhosis
  • Hepatitis
  • Right CHF
  • Renal failure
  • Pancreatitis

Written by lmwong

June 6, 2008 at 5:27 pm

Gallbladder Carcinoma

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  • 5th most common GI malignancy
  • stones are a risk factor
    • 75% have stones
    • chronic inflammation leads to epithelial dysplasia –> adenocarcinoma
  • 20% 5ys
  • 80% have direct tumor invasion at presentation
  • ST mass in GB lumen, partially or completely obliterates GB lumen
  • Greater than 1 cm (distinguish from polyp)
  • irregular, asymmetric and eccentric wall thickening
  • polypoid intraluminal mass
  • porcelain gallbladder
  • early spread to liver and lymph nodes
  • invades liver, bile ducts, portal veins
  • invades hepatoduodenal ligament –> CBD obstruction

Written by lmwong

June 6, 2008 at 5:21 pm