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Showing posts with label USG Gall Bladder. Show all posts
Showing posts with label USG Gall Bladder. Show all posts

Case 122: Adenomyomatosis of Gallbladder || Ultrasound

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Clinical Features:

A 70-year-old male patient came with right upper abdominal pain.


Ultrasound Features:

Generalized gallbladder wall thickening with multiple areas showing intramural hyperechoic foci and comet tail artifacts.


Remember:

- The high frequency ultrasound may help better visualization of comet tail artifacts & wall thickening.
- Search for mass lesion & calculus.


Ultrasound Diagnosis:

Chronic cholecystitis with adenomyomatosis of gallbladder.


Ultrasound Images:







Generalized gallbladder wall thickening with multiple areas showing intramural hyperechoic foci and comet tail artifacts.


YouTube Link:

For further demonstration, don't forget to check our video:

YouTube Link









Case 111: Empyema Gallbladder || Ultrasound

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Clinical Features:

A 42-year-old male came with

- Severe right upper abdominal pain

- Vomiting

- Positive Murphy’s sign


Ultrasound Features:

- Distended gallbladder with thickened & edematous wall with peri-cholecystic mild collection.

- Gallbladder lumen shows hypoechoic sludge. Within the sludge, tiny echogenic structures are also seen without posterior acoustic shadow. Rest of the lumen contains low-level echoes showing acoustic streaming.

- Mild hepatosplenomegaly.


Remember:

Acoustic streaming can help differentiate pus from sludge in empyema.


Ultrasound Diagnosis:

Acute cholecystitis with biliary sludge, microcalculi/soft calculi & features of empyema.


Ultrasound Images:



Mild hepatomegaly


Mild splenomegaly


Thick GB wall








Acute cholecystitis with biliary sludge, microcalculi/soft calculi & features of empyema.

YouTube Link:

For further demonstration, don't forget to check our video:

YouTube Link










Case 106: Cholelithiasis | Soft Calculus Mimicking Mass || Ultrasound

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Clinical Features:

A 35-year-old male patient came with right upper abdominal pain.


Ultrasound Features:

A bright echogenic structure without casting posterior acoustic shadow but moving along the posture changing is noted within the gallbladder lumen.


Remember:

The neck of the gallbladder is well visualized putting the probe longitudinally at the right subcostal region or at the right lower intercostal spaces with a sound beam directed towards the gallbladder.  


Ultrasound Diagnosis:

- Soft calculus in the gallbladder.


Ultrasound Images:




A bright echogenic structure without casting posterior acoustic shadow within the gallbladder lumen


On high-frequency ultrasound, movement of the stone with postue changing is well visualized



Reconstructed 3D image of the gallbladder calculus


YouTube Link:

For further demonstration, don't forget to check our video:

YouTube Link





Case 74: Thick Sludge or Soft Calculi of Gallbladder

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Ultrasound Features:

- Echogenic structures are noted within the gallbladder lumen without acoustic shadowing & moving along the posture changing


Ultrasound Images:



Echogenic gallbladder sludge mimicking worm 


Echogenic thick sludge or soft calculi


At sitting posture, the shape of the luminal contents has changed indicating sludge.







Case 53: Choledocholithiasis || Common Bile Duct Calculus

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Clinical Features:

A 50 years old male patient came with

- Severe right upper abdominal pain.

- Vomiting.


Ultrasound Features:

- Dilated common bile duct.

- A bright echogenic structure casting acoustic shadow is noted within the distal common bile duct lumen.

- Biliary sludge.


Remember:

Other imaging correlation is always safe to exclude distal common bile duct growth when we get a bile duct calculus.


Ultrasound Images:



Fig: Section of gallbladder showing luminal sludge


Fig: Section of gallbladder showing luminal sludge


Fig: Dilated common bile duct (CBD) with distal luminal echogenic calculus

Fig: Dilated common bile duct (CBD) with distal luminal echogenic calculus


Fig: High frequency view; Dilated common bile duct (CBD) with distal luminal echogenic calculus


YouTube Video Link:

https://youtu.be/jA_vi46GUp4








Case 33: Chronic Liver Disease (CLD)

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Chronic Liver Disease (CLD)


Clinical History:

  • 25 years old female with HBV infection

USG Findings:

  • Chronic liver disease (Early changes: mild irregularity & decreasing portal venous flow)
  • Thickened gallbladder wall
  • Gallbladder sludge
  • Mild splenomegaly
  • Splenunculus (Accessory spleen)
  • Displaced IUCD
  • Huge ascites (No bladder seen here)
  • Bilateral pleural effusion (Lt not shown here)



 Fig: Mild hepatic margin irregularity, thickened gallbladder wall with luminal sludge, huge ascites, right sided pleural effusion


Fig: Mild splenomegaly with splenunculus (Accessory spleen)


Fig: Decreasing portal venous flow (Patient on the post-prandial state)


Fig: Displaced IUCD at the lower uterine cavity, huge ascites 






Case 31: Worm in Gallbladder - Biliary Ascariasis

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Worm in Gallbladder - Biliary Ascariasis


  • Tubular luminal structure with central linear hypoechoic line.
  • Motile if alive, nonmotile if dead.
  • Echogenic without acoustic shadowing.
  • If calcified, it may cast acoustic shadow and get fragmented into several small pieces making confusion with cholelithiasis.


Ultrasound Images:

11 years boy with echogenic luminal dead worm







Video link of this case: https://youtu.be/N3QrmGSpsUo




More cases will be added soon in this post.



Case 20: Cholelithiasis

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Cholelithiasis

  • Luminal hyperechogenic structure/s
  • Casting posterior acoustic shadow/s
  • Moving or not moving along the posture changing
  • May be associated with cholecystitis
  • Common in Female, Fatty, Fertile, Forty, Fair (5F)



Case 19: Gallbladder Polyp - Multiple Cases

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Gallbladder Polyp

  • Hyperechogenic structure/s attached to the gall bladder wall.
  • No acoustic shadow.
  • Thickness upto 10 mm.
  • Not moves along posture changing/ Fixed
  • Peduncle is well visualized if magnified
  • Commonly missed if not searched using 'Zoom' option

Case 01:





Case 02:

Tiny echogenic gall bladder polyps, easily missed on nonmagnified images.