copyright 2008
Definition
A thickened gallbladder is a radiological finding in which the wall is thicker than the normal 2-3mm.in the fasting state. It is normally only about 1mm thick in the neonate. Thickening of the gallbladder wall is always abnormal, although the significance of the thickening is highly dependent upon the underlying disease process.
It can be caused by multiple factors and conditions including renal failure, liver failure heart failure, ascites, hypoproteinemia, and inflammation. Other causes include carcinoma, HIV cholangiopathy, slceroderma. In carcinoma the thickening may be focal or diffuse. Thickening may also be due to the hyperplastic cholecystoses, such as adenomyomatosis or hypercholesterolosis. Adenomyomatosis gives a more characteristically focal thickening, while cholesterolosis may be more diffuse. In general, most pathological processes affecting the gallbladder will cause thickening, either due to inflammation or due to precipitation of bile contents due to prolonged stasis.
The diagnosis is made on imaging studies. Ultrasound and CT are both sensitive to the diagnosis.
Treatment strategies are based on the cause of the wall thickening
82006c04.8s liver gallbladder blood supply hepatic artery cystic artery cystic arterioles submucosa wall edema hyperemic mucosa red = hepatic artery green = lumen of the gallbladder CTscan Courtesy Ashley Davidoff MD Copyright 2008 |
77717c02s right upper quadrant pain ICU setting RUQ pain gallbladder distended thick walled hyperemic enhancing wall pericholecystic induration dirty fat stranding acalculous cholecystitis Courtesy Ashley DAvidoff MD copyright 2008 |
77717c01s right upper quadrant pain ICU setting RUQ pain gallbladder distended thick walled sludge cholestasis tumefactive bile fluid in gallbladder fossa small shadowing stones acalculous cholecystitis shape of tumefactive bile in the gallbladder has fetus like formation USscan ultrasound Courtesy Ashley DAvidoff MD copyright 2008 |
00401.1cs 67Male right upper quadrant pain RUQ pain positive Murphy’s sign gallbladder gallbladder fossa thickened linear lacy thickening gall stones calculi calculous large stone in the infundibulum shadowing multiple small stones cholelithiasis cholecystitis acute cholecystitis acute calculous cholecystitis USscan ultrasound Courtesy Ashley Davidoff MD copyright 2008 |
48008c01 gallbladder thick wall non distended dx hepatitis USscan Davidoff MD |
77718.8s.jpg gallbladder thick wall filling defects stones cholelithiasis chronic cholecystitis enhancing wall acute cholecystitis on chronic pancreas normal MRI fat suppression gadolinium C+ Courtesy Ashley Davidoff MD copyright 2008 |
16239c.8s gallbladder stone cholelithiasis wall thickened thick wall enhancing wall dx chronic cholecystitis bile duct cholangiocarcinoma MRI with and without contrast |
25306.8s small cholesterol crystals stones floaters hyperemic wall chronic cholecytitis gas air cholelithiasis CTscan Courtesy Ashley Davidoff MD copyright 2008 |
30701.8s stone cholelithiasis hyperemic wall small contracted chronic cholecytitis stomach gastrostomy redundant mucosa CTscan Courtesy Ashley Davidoff MD copyright 2008 chronic cholecytitis |
81916.8s gallbladder stone cholelithiasis thick wall thickened wall small contracted chronic cholecystitis CTscan Courtesy Ashley Davidoff MD copyright 2008 |
2005H5~1.8s abdomen abdominal cavity peritoneal cavity free fluid ascites gaallbladder thick walled ultrasound ascites USscan Courtesy Philips Medical Systems copyright 2008 |
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00425 gallbladder wall fx edema dx CHF liver heart cardiac dx CHF liver CHF acute cardiac failure CTscan Courtesy Ashley Davidoff MD copyright 2008 |
calcified metastasis in gallbladder fossa edema of the wall lymphatics contracted gallbladder CTscan copyright 2008 Courtesy Ashley Davidoff MD gallbladder liver portal triad 82313c01.8s |
30464c02 32 female lungs pleura heart cardiac RA RV right ventricle right atrium pericardium gallbladder esophagus ILD basal interstitial lung disease pericardial effusion pleural effusion cardiomegaly enlarged esophagus patulous esophagus gallbladder wall edema congestive cardiac failure RHF right heart failure pulmonary hypertension cor pulmonale dx scleroderma CTscan Courtesy Ashley Davidoff MD |
and 30464c08 32 female lungs pleura heart cardiac RA RV right ventricle right atrium pericardium gallbladder esophagus ILD basal interstitial lung disease pericardial effusion pleural effusion cardiomegaly enlarged esophagus patulous esophagus gallbladder wall edema congestive cardiac failure RHF right heart failure pulmonary hypertension cor pulmonale dx scleroderma CTscan Courtesy Ashley Davidoff MD |
48010.800 gallbladder fx thick walled shadowing cholelithiasis complex fluid dx gallbladder empyema Courtesy Laura Feldman |
16228c01.8s gallbladder wall submucosal tumor = orange mucosal tumor = pink lumen = green thickened mucosa and submucosa carcinoma of the gallbladder CTscan Courtesy Ashley DAvidoff MD copyright 2008 |
Diffuse irregular thickening of the gallbladder wall in patient with gallbladder carcinoma.
16254c01b02.8s gallbladder thickened irregular wall air anterior wall small fluid collection gallbladder carcinoma complicated by perforation and abscess formation CTscan Courtesy Ashley Davidoff copyright 2008 |
16216c01.8s 32 male s/p trauma MVA gallbladder hyperemic mucosa thickened wall disrupted mucosa decompresssed lumen CTscan Courtesy Ashley Davidoff MD copyright 2008 |
References
Gallbladder Wall Thickening Web presentation from radiologyassistant.nl 5star
Van Breda Vriesman et al AJR