Gallbladder Stones: Imaging and Intervention

Abstract

Imaging of the gallbladder for cholelithiasis and its complications has changed dramatically in recent decades along with expansion of interventional techniques related to the disease. Ultrasonography (US) is the method of choice for detection of gallstones. The characteristic US findings of gallstones are a highly reflective echo from the anterior surface of the gallstone, mobility of the gallstone on repositioning the patient, and marked posterior acoustic shadowing. Oral cholecystography remains an excellent method of gallstone detection, but its role has been limited due to the advantages of US. Most people with cholelithiasis will not experience symptoms or complications related to gallstones. When biliary colic does occur, it is typically caused by transient obstruction of the cystic duct by a stone. The primary imaging modality in suspected acute calculous cholecystitis is usually US or cholescintigraphy. Detection of gallstones alone does not permit a diagnosis of acute cholecystitis; however, secondary US findings provide more specific information. In detection of choledocholithiasis, endoscopic retrograde cholangiopancreatography and magnetic resonance cholangiopancreatography are superior to US. In certain clinical settings, interventional radiologic procedures have become an important alternative to surgery in the treatment of gallstones and their complications; techniques include percutaneous cholecystostomy and gallstone removal.

Comparative study between ligature with thread or metallic clamping by means of laparoscopy with the purpose of experimental biliary obstruction in swines

“…In questionable cases or require additional supporting information, or, even, for differential diagnosis, the interpretation of clinical signs should always be correlated with laboratory tests, ultrasound exams or other methods of diagnostic imaging 2,13,47,51,52 . Ultrasound is a practical technique, fast and inexpensive, being considered as a screening assay in the initial evaluation of patients with suspected hepatobiliary tract disorders 7,8,12,13,53 , mainly due to its high sensitivity and specificity 1,16 . Through this examination, can visualize hepatomegaly in cases of cholestasis associated with obstruction, with the characteristic signs of increased volume of the organ and the presence of smooth margins, and there may be diffuse and increased echogenicity, and inadequate definition of the portal vessels; in biliary tract, is more common visualization increase of size in the gallbladder and dilation of ducts 12,16,17 .…”

“…There are several conditions that, in humans and animals, can cause obstruction in the biliary tree, occurring cholestasis [9][10][11][12][13] . However, in recent years, there was an increase in the diagnosis of asymptomatic lithiasis due to upgrading diagnostic methods routinely performed in patients [14][15][16][17] . Because of its frequency, many researchs are conducted to expand the knowledge about the pathogenesis and improving treatment of this disease 14,15,[18][19][20][21][22][23][24] .…”

When the non-contrast-enhanced phase is unnecessary in abdominal computed tomography scans? A retrospective analysis of 244 cases

“…It is a known fact that even utilizing the non-contrast-enhanced phase, the evaluation of cholelythiasis is limited at CT, with sensitivity ranging between 25% and 88%, Ultrasonography is the method of choice in the study of such a disorder (32,33) .…”

Intermittent gastric outlet obstruction due to a gallstone migrated through a cholecysto-gastric fistula: A new variant of “Bouveret’s syndrome”

“…It, therefore, represents the single best imaging technique for the diagnosis of gallstone ileus and Bouveret's syndrome [26] . It may also be helpful in assessing gallbladder wall thickness (signs of acute or chronic cholecystitis), content (air, residual gallstones) and biliary fi stula [5,26] . MRCP has recently been proposed as a useful tool for differentiating between fluid and gallstones and also for observing the fi stula when suffi cient fl uid is present [27] .…”

“…Biliary fistula is a rare complication (3%-5%) that is frequently preceded by an episode of acute cholecystitis [3,4] . Biliary fistula is mostly encountered in the duodenum although it can occur anywhere in the gastrointestinal (GI) tract [5] . Finally, just 7%-10% of biliary fi stulae cause gallstone ileus, an intestinal obstruction caused by a stone that has migrated through the fistula and stopped anywhere in the GI tract [6] .…”