Imaging Pearls ❯ Gallbladder ❯ Stone disease
|
-- OR -- |
|
- Choledocholithiasis
1. Present with pain, jaundice, pancreatitis
2. Elevated liver function tests
- 43% sensitive
- 30% PPV
3. Complications: cholangitis, sepsis
4. Isolated or in conjunction with cholecystitis
- 5-41% have concomitant stone in the duct
- Higher incidence of ductal calculi in elderly - Choledocholithiasis: Utrasound
1. Excellent modality for gallbladder imaging and detecting biliary obstruction
2. Lower sensitivity for choledocholithiasis
- 10% sensitive in nondilated ducts
- 17% sensitive if common bile duct dilated - Choledocholithiasis: Noncontrast CT
- 5 mm collimation CT compared to ERCP
- 88% sensitive
- 97% specific
- 94% accurate
- Small stones that are isodense to bile can be missed - Choledocholithiasis: MDCT
1. 4-slice MDCT in 72 patients (3.2 mm sections)
- With and/or without IV contrast
- ERCP correlation
2. 69-87% sensitive
3. 83-92% specific
4. 84-88% accurate
5. Pure cholesterol stones isoattenuating to bile - Acute Calculous Cholecystitis
Ultrasound is first line imaging modality
CT essential for evaluation of complicated cholecystitis
Higher sensitivity (CT 100% vs US 38%) in mixed group of patients with simple and complicated cholecystitis - Acute Cholecystitis: CT
- Gallstone
- Gallbladder distention
- Mural thickening
- Pericholecystic fluid and inflammation
- Hyperemia within the adjacent liver due to gallbladder inflammation - Gallbladder Pathology: Inflammatory
1. Acute cholecystitis: simple and complicated
- perforated
- gangrenous
- emphysematous
- hemorrhagic
2. Chronic cholecystitis
- chronic calculous cholecystitis
- xanthogranulomatous cholecystitis
3. Adenomyomatosis