Gallbladder wall thickening - not cholecystitis

Images by Genevieve Carbonatto

The gall bladder wall can be thickened in a number of different situations other than cholecystitis. This is important when assessing someone in Emergency with a thickened GB wall. The clinical situations needs to be taken into account before determining that the GB wall thickening is due to cholecystitis. The GB wall can also be thickened up to 4 hrs postprandially .

The following are causes of GB wall thickening (1)

Generalised oedematous states

Congestive heart failure
Renal failure
End Stage Cirrhosis

Inflammatory conditions

Primary

Acute cholecystitis
Cholangitis
Chronic cholecystitis

Secondary

Acute hepatitis
Perforated duodenal ulcer
Pancreatitis
Diverticulitis/colitis

Neoplastic conditions

Gallbladder adenocarcinoma
Metastases

Miscellaneous

Adenomyomatosis
Mural varicosities

The following are some cases of GB wall thickening not due to cholecystitis

Case 1

Patient with ascites and cardiac failure. GB wall thickness 1.06 cm. GB wall oedematous.

Case 2

Patient with Hepatitis C. Small GB with very thickened GB wall

Case 3

Patient with ascites.

Thickened GB wall 0.76cm, stone in neck of GB, ascites. Thickening of GB wall not due to cholecystitis but to pulmonary hypertension and liver failure. The stone in the neck of the GB makes this difficult to evaluate but the appearance of the GB had not changed over several months.

Case 4

Postprandial GB. GB wall is thickened. This is why the biliary exam should be done when the patient is fasted. Not only does the GB contract post prandially but the wall also becomes thickened.