Sonographic evaluation of Gall bladder
The Hepatobiliary system consists of the liver, gallbladder, bile ducts, and associated vasculature. Ultrasound is the primary imaging modality for
Sonographic evaluation of gall blader:
A.
Gall bladder Size and Shape
Shape: Pear-shaped, anechoic (fluid-filled).
Wall Thickness: ≤ 3 mm (measured at anterior wall in longitudinal plane).
Length: 70–100 mm
Transverse Diameter: 30–40mm
B. Echogenicity of Lumen:
Anechoic (clear, without internal echoes)
C. Diagnostic Applications
➤Gallstones (Cholelithiasis)
Echogenic foci with posterior acoustic shadowing.
Mobile: Stones move with patient repositioning.WES Sign (Wall-Echo-Shadow): Indicates a gallbladder full of stones.
➤Gallbladder Sludge
Low-level echoes within the lumen, no shadowing.May be gravity-dependent (moves with position change).
➤Gallbladder Wall Thickening
(>3 mm)
Causes:Cholecystitis (Acute/Chronic) – may show pericholecystic fluid, Murphy’s sign (+).Liver disease (Cirrhosis, Hepatitis)Congestive Heart Failure (CHF)
➤Acute Cholecystitis
Gallbladder wall thickening (>3 mm)Pericholecystic fluidPositive Sonographic Murphy's Sign (Pain over the GB during probe pressure).Hyperemic Wall on Doppler (Increased blood flow in inflamed wall).
➤Porcelain Gallbladder
Echogenic GB wall with posterior shadowing (calcification).High association with GB carcinoma.
➤Gallbladder Polyps
Non-shadowing fixed echogenic masses projecting from the wall.>10 mm size or rapid growth → Concern for malignancy.
D. Sonographic Techniques
· Gray-scale US: To assess shape, size, and presence of gallstones/sludge.
· Doppler US: To check for hyperemia (e.g., in acute cholecystitis).
· Compression Technique: Pain upon probe pressure → Murphy's Sign (+) (suggests acute cholecystitis).
· Color Doppler: Evaluate vascularity (e.g., hyperemia in infection).
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