The significance of sonographic gallbladder wall thickening

The value of gallbladder thickening in predicting the presence of acute cholecystitis was assessed by reviewing gallbladder sonograms for 150 normal patients, 15 fasting normal patients, 24 patients with proven acute cholecystitis, 24 patients with ascites or an alcoholic history, and 50 patients with surgically proven chronic cholecystitis and gallstones. Thickened gallbladder walls were found in all patients with ascites, 45 percent of patients with acute cholecystitis, and approximately 10 percent of those with chronic cholecystitis. The finding of gallbladder wall thickening is suggestive evidence of acute cholecystitis, but it is not a pathognomonic finding.     

Gallbladder wall thickening in dengue hemorrhagic fever: An ultrasonographic study

This study attempts to investigate whether gallbladder wall thickening (GBWT) measured by ultrasonography can be used in children as a reliable criterion to predict the onset of severe dengue hemorrhage fever (DHF). In this prospective study, we performed ultrasound examinations focusing on the gallbladder wall and the presence of intraperitoneal free fluid in 48 mild DHF cases (grades I–II) and 48 severe cases (grades III–IV). GBWT varied between 1 mm and 8 mm with a mean of 3.77 mm ± 2.04 mm. The mean value of DHF grades I and II (2.39 mm ± 1.48 mm) is significantly lower than that of grades III and IV (5.14 mm ± 1.54 mm), p < 0.001. GBWT exceeded 3 mm in only 16 of 48 (33.3%) grade I–II patients and in 45 of 48 (93.8%) grade III–IV patients. A significant positive correlation was apparent between GBWT and the severity of illness, p < 0.001. Patients with ascites have significantly thicker gallbladder walls than those without, p < 0.01. In clinically confirmed DHF cases, the sonographic finding of GBWT >3 mm to 5 mm, with 93.8% sensitivity, can be used as a criterion indicating the need for admission and monitoring. A GBWT of ?5 mm, with 91.7% specificity, is useful as a criterion for identifying DHF patients at high risk of developing hypovolemic shock. © 1995 John Wiley & Sons, Inc.     

非胆源性疾病中胆囊壁增厚的可能机制

胆囊壁增厚是较常见的超声表现,其不仅可见于胆源性疾病中而且亦可见于各种非胆源性疾病中。在非胆源性疾病中胆囊壁增厚的机制是多种多样的。本文对各种非胆源性疾病导致胆囊壁增厚的可能机制进行综述。     

Diffuse thickening of the gallbladder wall detectable during echography

Echographic examination of 3900 patients showed enlargement of the gallbladder wall in 3.5%. It was seen not only in cholecystitis but also in diffuse liver injury, portal hypertension, chronic heart failure and in other pathological conditions. Examples are given of 3 different sonographic versions of enlargement of the gallbladder wall. In some patients' groups (with diffuse liver injury, chronic heart failure, portal hypertension), a correlation was established between the thickness of the gallbladder wall and the diameter of the portal vein. It is assumed that echographic demonstration of the enlarged gallbladder wall in patients with diffuse liver injury may serve an early sign of portal hypertension.     

肝硬化患者合并胆囊壁增厚的临床分析

目的探讨肝硬化患者合并胆囊壁增厚的发生率及其机制。方法回顾性分析118例肝硬化组与165例住院健康体检对照组的B超及肝功能资料．比较肝硬化胆囊壁增厚发生率与性别、门静脉内径宽度、血清白蛋白浓度、凝血酶原时间、腹水及Child—pugh分级的关系。结果肝硬化组胆囊壁增厚者达80．51％,明显高于对照组,差异有统计学意义（x^2=180．74,P〈0．05）。与肝硬化胆囊壁正常组比较,肝硬化胆囊壁增厚组门静脉宽度增加、血清白蛋白浓度降低、凝血酶原时间延后、腹水发生率增加,差异均有统计学意义（t分别=2．26、9．18、4．43,x^2=-18．32,P均〈0．05）。与肝功能Child—pugh A组比较,Child—pugh B、Child—pugh C患者胆囊壁增厚发生率明显增加,差异有统计学意义（x^2=7．66、19．49,P均〈0．05）。结论肝硬化患者往往伴有胆囊壁增厚。肝硬化患者胆囊壁增厚的原因是多因素的。胆囊壁增厚对判断肝实质病变的严重程度有一定的参考价值。     

Gallbladder wall thickening: a frequent finding in various nonbiliary disorders--a prospective ultrasonographic study

A comprehensive prospective ultrasonographic study was performed in 93 patients to investigate gallbladder wall thickness and gallbladder volumes in various nonbiliary disease states. Without changes in gallbladder volume, mean gallbladder wall thickness was significantly increased (p less than 0.01) in patients with liver cirrhosis, viral hepatitis, chronic congestive heart failure, hypoalbuminemia, and chronic renal failure (p less than 0.05) but not in patients with diabetes mellitus (n = 14) as compared to a control group. The present study confirms that a variety of nonbiliary disorders are associated with significant thickening of gallbladder walls and that this finding is not caused by incomplete gallbladder contraction.     

Abdominal wall defects: two- versus three-dimensional ultrasonographic diagnosis.

We diagnosed 12 cases of abdominal wall defects. The cases diagnosed occurred in 6 fetuses with omphalocele, 3 with gastroschisis, 2 with prune-belly syndrome, and 1 with pentalogy of Cantrell. Except for 1 case of gastroschisis first diagnosed on the basis of three-dimensional ultrasonography at 14 weeks' gestation, all cases were first detected by two-dimensional transabdominal ultrasonography and then reevaluated with three-dimensional ultrasonography using multiplanar and orthogonal plane modes. Although the original diagnosis was accurate on the basis of two-dimensional ultrasonography in 11 of 12 cases, additional information was obtained by three-dimensional scanning in all cases. Our experience suggests that in cases in which abdominal wall defects are first detected by two-dimensional ultrasonographic scanning, the additional information gained by complementary three-dimensional ultrasonographic scanning can be useful for more-efficient counseling and postnatal therapeutic planning.     

门控心肌灌注显像室壁运动及室壁增厚率在鉴别前壁稀疏缺损中的价值

目的 评价门控心肌灌注显像（G-MPI）、室壁运动及室壁增厚率对前壁放射性稀疏缺损鉴别诊断的价值。方法以4种不同的方法来诊断前壁阳性：A心肌血流灌注图像阳性；B心肌血流灌注图像阳性且室壁运动阳性；C心肌血流灌注图像阳性且室壁增厚率阳性；D心肌血流灌注图像、室壁运动及室壁增厚率均阳性。以冠状动脉造影结果为标准，比较4种方法判断前壁稀疏缺损的准确性。结果4种方法判断前壁可逆性稀疏缺损的准确性分别为79．2％、91．7％、95．8％、100％，B、C与A差异无显著性，D与A差异有显著性；4种方法判断前壁固定性稀疏缺损的准确性分别为32．0％、80．0％、88．0％、92．0％，B、C、D与A差异均有显著性。结论G-MPI、室壁运动及室壁增厚率检测可提高前壁稀疏缺损的诊断准确性。     

慢性病毒性肝炎患者胆囊壁超声改变与肝脏组织病理关系的探讨

目的研究慢性病毒性肝炎胆囊壁声像图改变与病理炎症分级及肝纤维化分期的相关性,并探讨超声诊断胆囊炎的标准及其临床意义。方法正常对照组104例;病例组519例。对519例慢性肝炎患者,应用超声引导下肝组织取活检送病理检查,其中S1、S2、S3-S4分别为148例、170例、201例,G1、G2、G3～G4分别为124例、204例、191例,在肝穿7日内应用超声观察胆囊壁的声响图表现(光滑、毛糙、增厚毛糙、双边影征),将观察的结果与肝组织病理纤维化分期(S)和炎症分期(G)及临床化验进行对照分析。结果S分期中,有81%的病毒性肝炎患者胆囊壁有异常改变,其中胆囊壁有异常改变的S1分期有55%,S2分期有87%,S3～S4分期有96%。G分期中,有80%病毒性肝炎患者胆囊壁有异常改变,其中胆囊壁异常改变G1分期有45%,G2分期有82%,G3～G4分期有95%。在胆囊壁增厚一项中G1与G2、G2与G3～4之间均有显著性差异。结论胆囊壁声像图的异常与病毒性肝炎有着密切的关系,并随着肝炎病程的发展即G、S分期的程度增加而出现胆囊壁异常人数的增加。     

Gallbladder wall thickening: a new sign of gallbladder disease visualized by gray scale cholecystosonography.

The use of gray scale equipment in a prospective study of radiologically non-visualizing gallbladders, permitted detection of a new echographic aspect of gallbladder disease. Along with even, discrete bile thickening and the presence of sand-sized calculi, thickening of the gallbladder wall incholecystitis is another ultrasonographic sign of gallbladder disease that can be visualized successfully by gray scale ultrasound.     

肝炎肝硬化门静脉高压症胆囊壁增厚时的肝动脉血流动力学变化研究

目的探讨肝炎肝硬化门静脉高压症胆囊壁增厚时肝动脉的血流动力学变化。方法56例患者根据是否有门静脉高压和胆囊壁增厚分成三组：肝炎肝硬化门静脉高压症伴胆囊壁增厚（A组）、肝炎肝硬化门静脉高压症不伴胆囊壁增厚（B组）、有肝炎病史但无门静脉高压及胆囊壁增厚（C组）。彩色多普勒超声诊断仪检测肝动脉内径、收缩期峰值流速（PSV）、舒张末期流速（EDV）。结果A组中肝动脉内径、PSV、EDV较B、C组大,差异有统计学意义（P〈0．05）;B组与C组比较,差异无统计学意义（P〉0．05）。结论肝炎肝硬化门静脉高压症时肝动脉血流动力学改变参与胆囊壁增厚的病理生理机制。     

Gallstones preventing ultrasonographic visualization of the gallbladder

Ultrasonography can be used to diagnose the presence of multiple gallstones, despite the fact that the gallbladder, per se, may not be demonstrated. The finding of many echoes in the area occupied by the gallbladder that cast a large acoustical shadow is strongly suggestive of gallstones.     

泄殖腔外翻综合征前腹壁异常的产前超声诊断

目的总结胎儿泄殖腔外翻（OEIS）综合征前腹壁畸形产前超声声像图特征。 方法回顾性分析2008年1月至2017年3月湖北省妇幼保健院产前超声诊断的45例（46胎）OEIS综合征前腹壁异常胎儿超声声像图表现,并与引产胎儿标本尸检结果对比分析。 结果46胎OEIS综合征均经产后随访证实,26胎有详细的病理检查资料。OEIS综合征胎儿前腹壁畸形产前超声共同特点：胎儿膀胱未显影、低位的腹壁脐带插入处、胎儿下腹壁膨出物向胎儿两股骨间突起。根据膨出物特征46胎OEIS综合征胎儿产前超声声像图表现为5类畸形：（1）以囊性为主的混合性膨出物12胎。（2）脐下腹壁膨出物伴外翻22胎,伴象鼻征13胎。（3）下腹壁脐带根部膨出6胎。（4）大的腹裂畸形3胎。（5）脐膨出伴外翻3胎。 结论OEIS综合征胎儿前腹壁异常超声声像图表现复杂、多样,以囊性为主的混合性膨出物为OEIS综合征早期特有的超声表现,脐下腹壁膨出物伴外翻是OEIS综合征产前特征性表现。     

Gallbladder wall thickening in mononucleosis syndromes.

PURPOSE: We used sonography to measure gallbladder wall thickness in patients with mononucleosis syndromes and then evaluated laboratory data, spleen size, and clinical evolution to assess any relationship between gallbladder wall thickening (GBWT) and the severity of disease. METHODS: We retrospectively reviewed the medical records, sonograms, and sonographic reports of 39 patients who were diagnosed with mononucleosis syndromes on the basis of fever, tonsillopharyngitis, cervical adenopathy, hepatosplenomegaly, and lymphocytosis with atypical lymphocytes. All 39 were included in the study. The gallbladder wall thickness in each patient was sonographically determined. GBWT was defined as a wall thickness exceeding 3 mm. We assessed the laboratory data and clinical evolution in each patient, and the differences between patients with and without GBWT were statistically analyzed. RESULTS: Six patients (15%) had GBWT. The mean atypical lymphocyte count +/- standard deviation (SD) in the patients with GBWT (1,830/microl +/- 1,000/microl) was significantly higher than that in patients without GBWT (1,140/microl +/- 660/microl; p < 0.05). The mean total serum protein and serum albumin levels in the patients with GBWT (6.6 mg/dl +/- 0.7 mg/dl and 3.7 mg/dl +/- 0.5 mg/dl, respectively) were significantly lower than those in patients without GBWT (7.3 mg/dl +/- 0.4 mg/dl and 4.1 mg/dl +/- 0.3 mg/dl, respectively; p < 0.05). The duration of hospitalization in the patients with GBWT (14 +/- 8.5 days) was significantly higher than that in patients without GBWT (8 +/- 3.5 days; p < 0.05). CONCLUSIONS: GBWT in mononucleosis syndromes may be a sign of the severity of the illness and when present indicates the need to carefully monitor the clinical course.