The Common vein Copyright 2008

Definition

            Hepatization is a descriptive term for non-visualization of the gallbladder or difficulty discerning gallbladder from surrounding liver parenchyma under imaging.  It may be seen in CT, though it is commonly described in ultrasound imaging.  This is usually due to an underlying change in the tissue of the gallbladder parenchyma, as well as the liver itself.  Hepatization most commonly occurs when the gallbladder is filled with sludge, a viscous combination of concentrated calcium bilirubinate, mucus, and cholesterol crystals.  When this happens the gallbladder has roughly the same echogenic intensity and texture of the liver, and thus appears to be part of the liver.  Thus “hepatization” describes the phenomenon of the gallbladder appearing more liver-like.

When sludging occurs, the size of the gallbladder will be on the larger end of normal (60-70mL), as it is usually full and distended.  Its shape will thus be plump and pear-like.  In the setting of sludge accumulation the wall of the gallbladder may not be noticeable, although this is less newer generations of ultrasound and CT imaging.

There are no associated functional changes in the gallbladder, although sludge accumulation may be due to reduce contractility, prolonged fasting, or distal obstruction of the biliary tract.

Hepatization may also be used to describe changes in the liver that make it appear more gallbladder-like.  In the illustration below, fatty changes associated with liver disease make the liver parenchyma appear similar to the gallbladder contents.

Hepatization of the Gallbladder

78606c.8s liver with steatosis hepatization of the gallbladder density of the liver is the same as the bile in the gallbladder CTscan Courtesy Ashley Davidoff MD copyright 2008

Hepatization (b)

78606c.8s liver normal liver abnormal fatty change 777017 = a = acalculous cholecystitis b= pancreatitis with steatosis hepatization of the gallbladder density of the liver is the same as the bile in the gallbladder CTscan Courtesy Ashley Davidoff MD copyright 2008

References

Kawamura – Abdomen and Superficial Structures

Harbin – Nonvisualized gallbladder by cholecystosonography American Journal of Roentgenology, Vol 132, Issue 5, 727-728