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.

picture10

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.

Case 5

GB wall thickening due to pancreatitis. GB wall 0.51 cm

Case 6

Thickened GB wall secondary to heart failure. 

  • Thickening of GB wall
  • B lines of pulmonary oedema
  • Poor LV contraction in 4CV

 

 

 

 

 

 

Leave a Reply

Your email address will not be published.