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Gallbladder: Wall Thickening

10/02/12 00:00

The Radiology Assistant

Gallbladder: Wall Thickening
Adriaan C. van Breda Vriesman, Robin Smithuis, Dries van Engelen and Julien B.C.M. Puylaert
Radiology Department of the Rijnland Hospital, Leiderdorp; the Groene Hart Hospital, Gouda and the Medical Centre Haaglanden, the Hague, the
Netherlands

Introduction
Normal gallbladderThickened gallbladder wall
Differential diagnosis of gallbladder wall thickening
Primary gallbladder disease
Acute cholecystitis
Acalculous cholecystitis
Chronic cholecystitis
Xanthogranulomatous cholecystitis
Porcelain gallbladder
Gallbladder carcinoma
Adenomyomatosis
Secondary gallbladder involvement
Liver cirrhosis
Hepatitis
Congestive right heart failure
Pancreatitis
ConclusionPublicationdate: 1-2-2006
Thickening of the gallbladder wall is a relatively
frequent finding at diagnostic imaging studies.
Historically, a thick-walled gallbladder has been
regarded as proof of primary gallbladder disease, and
it is a well-known hallmark feature of acute
cholecystitis.
The finding itself, however, is non-specific and can be
found in a wide range of gallbladder diseases andextracholecystic pathological conditions.
In this review we discuss and illustrate the various
causes of a generalized thickened gallbladder wall.
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Introduction

Sonography, CT and MRI all allow direct visualization
of the normal and thickenedgallbladder wall.
Traditionally, sonography is used as the initial
imaging technique for evaluating patients with
suspected gallbladder disease, because of its high
sensitivity in the detection of gallbladder stones, its
real-time character, speed and portability [1].
However, CT has become popular for evaluating the
acute abdomen and often is the first modality to
detect gallbladder wallthickening [2], or it may be
used as an adjunct to an inconclusive sonography or
for staging of disease.
The potential value of MRI in the evaluation of
gallbladder pathology has been shown [3], but it still
plays little role.

Distended hydropic and hyperemic gallbladder in acute
cholecystitis due to stone obstruction in the gallbladder
neck or cystic duct.http://www.radiologyassistant.nl/en/43a0746accc5d

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Gallbladder: Wall Thickening

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Normal gallbladder
The normal gallbladder wall appears as a pencil-thin
echogenic line at sonography.
The thickness of the gallbladder wall depends on the
degree of gallbladder distention and pseudothickening
can occur in the postprandial state.

LEFT: US of a normal gallbladder after an overnightfast
shows the wall as a pencil-thin echogenic line (arrow).
RIGHT: US in the postprandial state shows
pseudothickening of the gallbladder
The normal gallbladder wall is usually perceptible at
CT as a thin rim of soft-tissue density that enhances
after contrast injection.

Contrast-enhanced CT shows the normal gallbladder wall as
a thin rim of enhancing soft-tissue
Thickened gallbladderwall
Thickening of the gallbladder wall is a relatively
frequent finding at diagnostic imaging studies.
A thickened gallbladder wall measures more than 3
mm, typically has a layered appearance at
sonography [1], and at CT frequently contains a
hypodense layer of subserosal oedema that mimics
pericholecystic fluid [2]

LEFT: US in a 59-year-old woman with acute cholecystitis
shows thelayered appearance of a thickened gallbladder
wall, with a hypoechoic region between echogenic lines
RIGHT: At contrast-enhanced CT the thick-walled
gallbladder contains a hypodense outer layer (arrow) due to
subserosal oedema

http://www.radiologyassistant.nl/en/43a0746accc5d

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Gallbladder: Wall Thickening

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Differential diagnosis of gallbladder wall...
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