A patient who had been jaundice for more than four months was examined with diagnostic ultrasound. Ultrasound examination revealed that the patient had a solid-appearing mass in the region of the gall bladder, in addition to findings diagnostic of obstructive jaundice. A probable mass was also noted in the head of the pancreas. The clinical data and representative echographic pictures are presented to emphasize the point that sludge within the gall bladder is echogenic and appears more solid than cystic on a standard echographic examination.
Significant sonic shadowing originating from a structure within the hepatic parenchyma is unusual and often denotes pathology. The differential diagnosis (choledocholithiasis, air in the biliary tree, calcified tissue, foreign bodies, and shadowing from normal structures) is reviewed and examples are presented.
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