Pitfall – Stones in the gall bladder – Adenomyomatosis

Images Ying Ying Lee, text Genevieve Carbonatto A 44 year old man presents with acute abdominal pain. His pain is mainly epigastric but you are concerned about the possibility of cholecystitis, cholelithiasis or choledocholithiasis. While scanning the patient in the supine position, you think you can see stones in the GB. They do not appear Read more about Pitfall – Stones in the gall bladder – Adenomyomatosis[…]

Empyema of the gallbladder

Images by Bashir Chakar    A  patient presents with fever and abdominal pain . Multiple fibrin septations are seen within the gallbladder. 12 hours post admission he had a cholecystectomy. During the operation he had  free drainage of pus from the gallbladder. Scanning though the gallbladder, multiple thin fibrin septations are seen. Thickened GB wall, Read more about Empyema of the gallbladder[…]

Stone in neck, but mobile

Images by Genevieve Carbonatto   A patient presents with acute onset epigastric pain associated with vomiting.  The decision is made to examine his GB for the possibility the cause being biliary colic. The following is his ultrasound. There is a 2.19 cm stone in the neck of the GB. Could this be the cause of Read more about Stone in neck, but mobile[…]

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 Read more about Gallbladder wall thickening – not cholecystitis[…]


Images by Genevieve Carbonatto These are reverberation artifacts produced because sound waves reverberate between the cholesterol crystals and the wall of the gallbladder. Colour Doppler: The wall of the GB  seems to light up like a  christmas tree due to these reverberation artifacts.                           Read more about Adenomyomatosis[…]


Images by Genevieve Carbonatto Ultrasound is the best imaging modality to diagnose cholecystitis. Cholecystitis is a frequent presentation to the Emergency department. The hall marks include Thickening of the gallbladder wall > 3mm Gallstones Impacted stones in the cystic duct or gall bladder neck Pericholecystic fluid +ve Murphy’s sign Hyperaemic gallbladder wall on colour or power Read more about Cholecystitis[…]

Gallstone + tumification of sludge

Images by Tina Cullen    A patient presents with abdominal pain. Examination of the gall bladder using ultrasound shows a solid rounded looking “tumified” sludge in the  gallbladder.  The stone casts an acoustic shadow and is in the neck of the gallbladder.  Colour Doppler can be  used to look to confirm this is not a tumour. There Read more about Gallstone + tumification of sludge[…]