Surgical and pathologic correlation of cholecystosonography and cholecystography.

To define the accuracy of varying ultrasonic patterns in the diagnosis of gallstones, the records of 145 patients with ultrasound examination of the gallbladder prior to cholecystectomy were reviewed. Three abnormal scan categories were established: category 1--shadowing opacities that move with gravity within the gallbladder lumen; category 2--nonvisualization of the gallbladder lumen; and category 3--nonshadowing opacities within the gallbladder lumen. The accuracy of these criteria for gallstone diagnosis was found to be 100%, 96%, and 61%, respectively. Overall accuracy was 96% for gallbladder disease, with a 4% false negative rate. Oral cholecystography demonstrated an accuracy of 93% in this series. A preoperative ultrasound diagnosis of gallstones should probably be limited to category 1 and 2 appearances only.     

胆囊颈部结石超声诊断影像学分析

目的探讨超声在胆囊颈部结石诊断中的应用价值。 方法对我院2011年至2019年彩超诊断为胆囊颈部结石的201例患者的超声声像图特征进行回顾性分析。所有患者均在我院普外科接受保胆取石手术时得以证实。 结果201例胆囊颈部结石中有96例出现胆囊体积增大并积液,占47%;176例出现胆囊壁增厚,占87%;47例出现胆泥团,占23%;35例出现胆囊缩小,占17%;145例出现胆绞痛发作史,占72%。 结论在胆囊颈部结石的诊断中,当超声检查出现以下几点应高度提示胆囊颈部结石的可能性：（1）胆囊体积增大合并积液;（2）胆囊壁明显增厚,胆汁暗区呈云雾状改变;（3）胆囊腔内有多个胆泥团;（4）胆囊缩小,胆囊内仅见极少许胆汁;（5）有反复发作的胆绞痛病史。要重点观察胆囊颈部情况,以提高胆囊颈部结石的检出率,减少漏诊。     

飞行人员胆囊结石的空中B超观察

旨在观察飞行中胆囊结石有无位移及能否诱发空中突然失能。采用日本SDL－32型B超诊断仪，对16名飞行人员胆囊结石患者进行了地面及空中观察。结果表明，地面观察未见胆囊结石有明显位移；跟班飞行观察，从飞机爬升经巡航到下滑几个阶段内，胆囊结石保持原位不动者9例（共有块状结石7枚，泥沙状结石3堆），其中结石位于胆囊颈部3例、胆囊体部6例，为滞留型；结石发生了位移者7例（共有块状结石13枚），其中结石由胆囊颈部降到胆囊体部者4例、由胆囊体部落到胆囊底部者2例，在胆囊体部前后壁间横向移位者1例，为游移型。游移型结石有可能速入胆道，引起突然失能，危及飞行安全，应密切观察。     

Sonographic evaluation of resting gallbladder volume and postprandial emptying in patients with gallstones

We investigated fasting gallbladder volume and gallbladder emptying in response to a fatty meal in 20 patients with asymptomatic gallstones and compared the results with findings from healthy controls. Compared with control subjects without gallstones, the majority of patients with gallstones exhibited a higher resting gallbladder volume, less fractional emptying after a fatty meal, and a higher postmeal residual volume. These abnormalities all appeared to stem from an abnormally high resting gallbladder volume. Whether the increased gallbladder volume and decreased postprandial fractional emptying in the gallstone patients represents a primary or secondary abnormality remains to be determined. The results suggest that in some patients decreased gallbladder contractility may contribute to gallstone development or proliferation.     

Peritoneal abscess formation as a late complication of gallstones spilled during laparoscopic cholecystectomy.

The case is described of a 74-year-old woman who presented with an abdominal abscess 1.5 years after laparascopic cholecystectomy. CT and ultrasound showed the presence of gallstones within the abscess. Spillage of gallstones from perforation of the gallbladder is a well recognized complication of laparascopic cholecystectomy, although subsequent abscess formation is unusual especially after a long delay as in this case.     

Dissolution of gallstones using methyl tertiary-butyl ether in an animal model

Human gallstones were surgically implanted in the gallbladders of six pigs. Through cholecystostomy catheters, methyl tertiary-butyl ether (MTBE) was infused from 3 to 5 days. MTBE successfully dissolved 19 of the 20 cholesterol stones and partially dissolved one mixed cholesterol-bilirubin stone. Gross and microscopic examination of abdominal organs revealed mild superficial ulcerations of the gallbladder and mild to moderate chronic inflammatory changes in the gallbladder of animals treated with MTBE infusion. There were no other significant changes within other abdominal organs except for mild inflammation of the duodenum in one animal and of the common bile duct in another. Because of its efficacy and limited deleterious effects, MTBE may be a good solvent when dissolving pure cholesterol gallstones in the gallbladder.     

Motor function of the gallbladder: measurement and clinical significance

Abnormalities in gallbladder emptying commonly occur in gallstone patients. Similar changes can be found in patients without gallstones that have disease that may predispose to stones, such as diabetes. Decreased contractility of the gallbladder can be measured clinically with variety of radiological techniques, and ultrasonography seems to have a number of advantages over others. In addition to a role in pathogenesis, decreased gallbladder emptying may determine the clearance of gallstones from the gallbladder during dissolution and after lithotripsy.     

Gallbladder carcinoma: radiologic-pathologic correlation.

Primary carcinoma of the gallbladder is an uncommon, aggressive malignancy that affects women more frequently than men. Older age groups are most often affected, and coexisting gallstones are present in the vast majority of cases. The symptoms at presentation are vague and are most often related to adjacent organ invasion. Therefore, despite advances in cross-sectional imaging, early-stage tumors are not often encountered. Imaging studies may reveal a mass replacing the normal gallbladder, diffuse or focal thickening of the gallbladder wall, or a polypoid mass within the gallbladder lumen. Adjacent organ invasion, most commonly involving the liver, is typically present at diagnosis, as is biliary obstruction. Periportal and peripancreatic lymphadenopathy, hematogenous metastases, and peritoneal metastases may also be seen. The vast majority of gallbladder carcinomas are adenocarcinomas. Because most patients present with advanced disease, the prognosis is poor, with a reported 5-year survival rate of less than 5% in most large series. The radiologic differential diagnosis includes the more frequently encountered inflammatory conditions of the gallbladder, xanthogranulomatous cholecystitis, adenomyomatosis, other hepatobiliary malignancies, and metastatic disease.     

胆囊癌的CT诊断及鉴别诊断(附33例报道)

目的:探讨胆囊癌的CT表现及鉴别诊断.方法:33例经手术病理证实的胆囊癌,对其CT表现进行观察分析.结果:胆囊癌以老年女性多见,临床表现为黄疸及腹部肿块、纳差.CT表现:胆囊区肿块,密度不均,胆囊腔缩小或消失;胆囊壁增厚,呈局限性或弥漫性不规则增厚;胆囊腔内软组织块影;合并胆结石;肝内外胆管扩张;肝脏直接受侵范;肝脏转移,侵犯腹壁,合并腹水.增强扫描可见病灶中度及明显强化.病灶周围及邻近器官侵犯、淋巴结转移更有助于诊断.结论:仔细观察胆囊及其周围结构、邻近器官改变,旨在提高胆囊癌的诊断正确率.     

Sonography of adenomyomatosis of the gallbladder: radiologic-pathologic correlation

Sonograms of six patients with adenomyomatosis of the gallbladder were reviewed and correlated with oral cholecystographic and pathologic findings. The gallbladder was visualized in four of the six patients by oral cholecystography, which also revealed intramural diverticula. Five of the six patients showed sonographic evidence of diffuse or segmental thickening of the gallbladder wall and intramural diverticula, seen as anechoic or echogenic foci within the wall. Intramural diverticula containing bile appeared as anechoic spaces; those containing biliary sludge or gallstones appeared as echogenic foci with or without acoustic shadows or reverberation artifacts. There was good correlation between sonographic and pathologic findings in three patients. The authors conclude that adenomyomatosis of the gallbladder should be suspected when (a) there is diffuse or segmental thickening of the gallbladder wall and (b) intramural diverticula are seen as anechoic or echogenic foci with or without associated acoustic shadows or reverberation artifacts.     

Fetal gallstones

Routine obstetric ultrasound (US) examinations in a 33-year-old woman revealed a normal fetal gallbladder at 24 menstrual weeks but multiple structures in the gallbladder with findings typical of gallstones at 37 menstrual weeks. No other abnormalities were present. Three days after a term delivery, an abdominal US examination again demonstrated multiple gallstones. When the infant was 6 weeks old, a follow-up abdominal US study showed no evidence of gallstones. This case, as well as one previously reported, demonstrates that findings typical of gallstones may be seen in the fetus, and that these structures may spontaneously resolve.     

Nonvisualized gallbladder by cholecystosonography.

To further define the significance of gallbladder nonvisualization by cholecystosonography, we studied follow-up data on 25 consecutive patients in whom the gallbladder could not be identified despite adequate fasting. In one patient, intravenous cholangiography demonstrated a large gallbladder but no gallstones. In the 24 cases for which a pathoanatomic diagnosis was established, all but two had diseased gallbladders with obliteration of the lumen. This 88% accuracy for positive prediction confirms results of previous sonographic studies and matches the diagnostic significance of nonvisualization at oral cholecystography. We recommend oral cholecystography for all ultrasonic nonvisualized gallbladders for greater diagnostic accuracy when surgery is contemplated.     

Percutaneous rotational contact biliary lithotripsy: initial clinical results with the Kensey Nash lithotrite

The percutaneous rotary lithotrite introduces a new concept to fragmentation and percutaneous removal of gallstones. A fluid vortex is generated, pulling calculi into a high-speed blade that fragments stones to predominantly under 500 microns. The results of treating the first 10 patients with this instrument reveal that large stone burdens as well as small stones (2-3 mm) of any composition can be removed if the gallbladder is of sufficient size to accommodate the six-pronged basket. Rotation times of 7-39 minutes were required. Nine of 10 procedures were completed; access was lost in one case. One major complication occurred. At repeat oral cholecystography, the gallbladder was visualized after 3-6 weeks in eight of the nine patients. Ursodeoxycholic acid was administered from 3 to 12 months to five patients with either residual stones or aggregates. The hospital stay ranged from 48 to 72 hours. All patients (except the patient who underwent surgery) resumed light activity in 3-4 days and strenuous activity and full diet within 3 weeks.     

Echographic study of gallbladder contraction: normal and pathologic aspects. Apropos of 115 patients

The gallbladder volume was measured on abdominal ultrasonography in 115 patients consisting of three population groups, before and after ingestion of a fatty meal and/or intravenous administration of cholecystokinin. The variation in volume, estimated as a percentage, was used to assess gallbladder contraction. The first group, consisting of 40 normal individuals without gallstones or impaired gallbladder or hepatic function, can be considered to constitute a control group. In this population, gallbladder contraction exceeded 50% in every case. The second group consisted of 40 cases of acute cholecystitis, including 30 cases with acute gallstones and 10 cases of stone-free acute cholecystitis proven surgically (7 cases) or by guided aspiration (3 cases). Gallbladder contraction was less than 15% in every case. Lastly, a third group of 35 patients with uncomplicated gallstones discovered on routine ultrasonography, demonstrated gallbladder contraction of between 10 and 85%. In this last group, 12 patients with vague gastrointestinal symptoms and gallbladder contraction less than 15% were operated: the histological results demonstrated severe lesions of chronic gallstone cholecystitis. The authors believe that absent or weak gallbladder contraction after endogenous stimulation is a supplementary sign to be taken into consideration in a context suggestive of the diagnosis of acute stone-free cholecystitis and to suggest, in the presence of gastrointestinal symptoms not directly related to the gallbladder, the hypothesis of chronic gallstone cholecystitis.     

Ultrasonic detection of gallstone ileus

A woman of 60 years of age with acute abdominal pain, vomiting, constipation and radiological signs of small bowel obstruction was subjected to sonographic examination. Careful examination of the entire abdomen demonstrated a hyperechoic object within the distended terminal ileum with an intensive acoustic shadow. The gallbladder was not visible. This strongly suggested gallstone ileus, especially since the patient had a history of gallbladder disease. She was treated immediately by enterotomy and extraction of a noncalcified obstructing stone. The value of ultrasound in detecting gallstones causing small bowel obstruction is discussed.     

Dissolution of gallstones using cholecystostomy tube in the pig

Cholecystostomy catheters and human cholesterol gallstones were implanted surgically in the gallbladders of eight pigs. Through the catheters, mono-octanoin or sterile water (H2O) was infused from two to seven days. The mono-octanoin dissolved pure cholesterol gallstones smaller than 200 g. There was no stone dissolution with infusion of sterile water and only one stone larger than 250 g was dissolved with mono-octanoin. Side effects included moderate-to-severe inflammation and ulceration of the gallbladder with mono-octanoin instillation, which precludes its widespread use with the present treatment regimen. Infusion of water caused little gallbladder irritation.     

Gas-containing gallstones: value of the "Mercedes-Benz" sign at CT examination

Gas-containing gallstones are well-known in vitro. The typical triradiate arrangement of fissures filled with gas, first described on abdominal plain films, was named by Meyers the "Mercedes-Benz" sign. This sign is absent of the recent literature. We report a case where gas was the only CT sign suggesting the presence of gallstones in the gallbladder.     

Gray scale ultrasonography of the gallbladder: an evaluation of accuracy and report of additional ultrasound signs.

Ultrasound examinations of 76 patients with suspected gallbladder disease were compared with radiographic, surgical, and pathologic findings to determine the accuracy of the ultrasound examinations. In 13 of the 76, the gallbladder was not visualized by ultrasound. Diagnosis of the presence or absence of gallstones was correctly made by ultrasound in 56 of 63 visualized gallbladders, for an accuracy rate of 89%. A high proprtion of nonvisualized gallbladders (10 or 13) contained gallstones. Previously unreported ultrasound findings of a stone impacted in the proximal cystic duct and findings of a collection of bile in the lesser sac associated with cholelithiasis and choledocholithiasis are illustrated.     

Gallbladder function in diabetic patients

Gallbladder emptying and filling was studied in eight diabetic and six normal control patients. None of the patients had gallstones. Cholescintigraphy was performed using [99mTc]disofenin, and gallbladder emptying was studied using a 45-min i.v. infusion of the octapeptide of cholecystokinin (OP-CCK) 20 ng/kg X hr. The peak filling rate was greater in diabetic than in normal subjects; however, emptying of the gallbladder in response to OP-CCK was significantly less in the diabetic subjects (51.6 +/- 10.4% compared with 77.2 +/- 4.9%). When the diabetic group was subdivided into obese and nonobese diabetics, the obese diabetics had a much lower percentage of emptying than the nonobese diabetics (30.0 +/- 10.4% compared with 73.1 +/- 9.3%). These findings suggest that obese diabetics may have impaired emptying of the gallbladder even in the absence of gallstones. The more rapid rate of gallbladder filling in obesity may indicate hypotonicity of the gallbladder. The combination of these abnormalities may predispose the obese diabetic to the development of gallstones.     

Percutaneous gallstone lithotripsy. Results in acute and chronic swine models

The authors describe here a rotary catheter for the percutaneous fragmentation of gallstones. Gallstones are drawn into the rotating impeller by a powerful vortex and mechanically fragmented. Fragments are aspirated from the gallbladder following use of the device. The safety and efficacy of the device was tested after placement of human gallstones in the pig's gallbladder in 19 acute, 15 chronic, and two control experiments. In 27 completed experiments, 206 human gallstones (6-20 mm) were implanted. Most residual fragments were less than 2 mm; 24 fragments were 2 to 4 mm and seven were 5 to 8 mm. Acute histologic changes included focal loss of mucosa, mucosal and submucosal hemorrhage, and deposition of biliary material in the mucosa and submucosa. At 30 and 90 days, gallbladder histology revealed regeneration of the mucosa with isolated granuloma formation.