Aberrant pancreas in the gallbladder wall

We present three cases of heterotopic pancreas in the gallbladder wall. The patients (all female) presented with abdominal pain. Ultrasonography revealed polypoid tumor with coexistence of lithiasis in two cases. All patients underwent cholecystectomy. Microscopy revealed chronic cholecystitis and cholesteatosis and heterotopic pancreatic tissue. Heterotopic pancreas in the gallbladder wall is a rare heterotopia, with 23 cases reported in the international literature. Received 21 March 1996; Revision received 4 September 1996; Accepted: 9 December 1996     

An unusual thickening of the gallbladder wall in cholecystitis

This is a report on a massive thickening of the gallbladder wall accompanying an acute cholecystitis with cholelithiasis. The sonographic criteria for the diagnosis of cholecystitis are discussed. It is pointed out that a thickening of the gallbladder wall is not a specific sign for cholecystitis.     

Sonography of the gallbladder: significance of striated (layered) thickening of the gallbladder wall

Sonographic identification of thickening of the gallbladder wall that consists of multiple striations (alternate hypoechoic and hyperechoic layers) has been considered strong evidence of the presence of acute cholecystitis. We studied 27 patients in whom sonograms showed striated thickening of the gallbladder wall to determine the diagnostic significance of this finding. Striations were classified as focal or diffuse. Sonograms were correlated with pathologic findings in 16 patients and with clinical diagnoses and laboratory findings in 11. Patients were categorized as having cholecystitis with or without gangrene or edema of the gallbladder wall unrelated to gallbladder disease. Striated thickening of the gallbladder wall was due to cholecystitis in 10 patients, and all 10 had gangrenous changes at surgery or at pathologic examination. Striations were focal in eight of these patients and diffuse in two. Striated thickening of the gallbladder wall was due to edema of the wall unrelated to gallbladder disease in 17 patients. Causes included congestive heart failure (n = 4), renal failure (n = 5), liver disease (hepatic failure [n = 1], hepatitis [n = 6]), ascites (n = 2), hypoalbuminemia (n = 3), pancreatitis (n = 1), blockage of the lymphatic/venous drainage of the gallbladder (n = 2), and prominent Rokitansky-Aschoff sinuses (n = 1). More than one abnormality was present in five patients. Striations were focal in 11 of these patients and diffuse in six. The sonographic finding of striated gallbladder wall thickening is no more specific for cholecystitis than the observation of gallbladder wall thickening by itself, and it may occur in a variety of diseases. However, in the clinical setting of acute cholecystitis, the presence of striations suggests gangrenous changes in the gallbladder. The extent of the striations (focal or diffuse) is not useful in predicting the cause of the striated gallbladder wall thickening.     

Infusion tomography of the gallbladder: mechanism of gallbladder wall opacification in experimental acute cholecystitis.

A canine model of acute cholecystitis was used to determine the mechanism of opacification of the gallbladder wall by infusion tomography. The experimental data indicate that opacification of the thickened wall of the gallbladder in acute cholecystitis is a function of hypervascularity and transport of the radiopaque material across the capillary wall by polymorphonuclear cells. Tissue-fluid equilibration of the contrast agent may also play a role.     

Local tumefaction of the gallbladder wall due to pancreatic heterotopia

A 38-year-old woman was examined because of vague abdominal symptoms. Cholecystography and US studies demonstrated a lobulated tumor, 14 mm in length, with a homogeneous structure, sharp limits, adjacent to the posterior wall of the gallbladder and producing no acoustic shadow. Pathological examination demonstrated subserosal pancreatic heteropia. More than 22 different kinds of focal lesions affecting the gallbladder wall have been described. Unfortunately, no clinical or US criteria allow a definite diagnosis. Only the size makes a difference: more than 94% of the adenomas measuring less than 10 mm are benign whereas 88% of the malignant lesions are over 10 mm. Considering the absence of specific criteria, surgical removal is therefore indicated for lesions over 10 mm.     

Diffuse gallbladder wall thickening: differential diagnosis

OBJECTIVE: The objective of our study was to review and illustrate the various clinical entities that may cause diffuse thickening of the gallbladder wall on diagnostic imaging studies. CONCLUSION: Diffuse gallbladder wall thickening may be caused by a wide range of gallbladder diseases and extracholecystic pathologic conditions. In most cases its cause can be determined by correlation of the clinical presentation and associated imaging findings.     

The urinal artifact

Abrupt narrowing of the male anterior urethra has been increasingly observed during voiding cystourethrography due to extrinsic pressure from a urinal. The true nature of this narrowing must be recognized to avoid misinterpretation.     

Sonography of thickened gallbladder wall: causes in children

A review of 793 consecutive abdominal sonograms in children aged 1 day to 16 years disclosed 453 patients in whom the gallbladder was clearly visible on at least two perpendicular views. Twenty had a gallbladder wall more than 3 mm thick. The following diseases were associated with gallbladder wall thickening; hypoalbuminemia (13 cases), ascites (five, three with concomitant hypoalbuminemia), physiologic thickening because of partial wall contraction (one), and systemic venous hypertension (one). None of 26 patients with gallstones and one of 14 with sludge had a thickened gallbladder. (The latter patient had concomitant hypoalbuminemia). Five patients with surgically proven acute cholecystitis during this same interval of time had sonograms. In four, the gallbladder wall was of normal thickness. In the fifth patient, the gallbladder wall could not be visualized because of densely shadowing stones. In this population, thickening of the gallbladder wall was not associated with acute cholecystitis and thus was not an indication for cholecystectomy.     

Endoscopic ultrasonography for demonstrating loss of multiple-layer pattern of the thickened gallbladder wall in the preoperative diagnosis of gallbladder cancer

The purpose of this study was to elucidate the roles of endoscopic ultrasonography (EUS), conventional US, CT, and MRI in differential diagnosis of gallbladder wall thickening. We scrutinized images for the presence of the multiple-layer patterns of the thickened gallbladder walls during preoperative images (EUS, n = 22; US, n = 23; CT, n = 20; MRI, n = 15) and retrospectively correlated them with surgical results in 25 patients. The pathological diagnoses included 7 gallbladder cancers, 9 cases of chronic cholecystitis, 5 cases of xanthogranulomatous cholecystitis, and 4 cases of adenomyomatosis. Multiple-layer patterns of gallbladder wall were observed in patients with inflammatory and benign diseases by US, EUS, CT, and MRI. This pattern was demonstrated by EUS more efficiently compared with other means of imaging. All subjects with loss of multiple layers were finally diagnosed by use of EUS as having gallbladder cancer at surgery. Loss of multiple-layer patterns of the gallbladder wall demonstrated by EUS was the most specific finding in diagnosing gallbladder cancer. Received 29 July 1996; Revision received 27 November 1996; Accepted 21 January 1997     

False-positive CT diagnosis of gallstones due to thickening of the gallbladder wall

An erroneous CT diagnosis of cholelithiasis was made at our institution during the past year in seven patients who had thickening of the gallbladder wall. In all cases the mucosa, which had a high attenuation value, was misinterpreted as a calcified stone, and the low-attenuation thickened submucosa was misinterpreted as intraluminal bile surrounding the stone. Depending on the attenuation of the actual intraluminal bile, the pseudostone appeared peripherally calcified (five patients) or uniformly calcified (two patients). Careful analysis of the position and configuration of a suspected stone and of the outer margin of the gallbladder can help avoid an incorrect CT diagnosis of gallstones when high-attenuation thickened mucosa simulates a gallstone and low-attenuation submucosa looks like surrounding bile.