New Developments in the Ultrasonography Diagnosis of Gallbladder Diseases

Abstract

Gallbladder diseases are very common, and their diagnosis is based on clinical–laboratory evaluation and imaging techniques. Considering the different imaging diagnostic tools, ultrasound (US) has the advantage of high accuracy combined with easy availability. Therefore, when a gallbladder disease is suspected, US can readily assist the clinician in the medical office or the emergency department. The high performance of US in the diagnosis of gallbladder diseases is mainly related to its anatomic location. The most frequent gallbladder pathological condition is gallstones disease, easily diagnosed via US examination. Acute cholecystitis (AC), a possible complication of gallstone disease, can be readily recognized due to its specific sonographic features. Additionally, a number of benign, borderline or malignant gallbladder lesions may be detected via US evaluation. The combined use of standard B-mode US and additional sonographic techniques, such as contrast-enhanced ultrasonography (CEUS), may provide a more detailed study of gallbladder lesions. Multiparametric US (combination of multiple sonographic tools) can improve the diagnostic yield during gallbladder examination.

The Diagnosis and Treatment of Acute Cholecystitis: A Comprehensive Narrative Review for a Practical Approach

“…A defect of the gallbladder wall ("hole sign") represents the direct visualization of parietal perforation (Figure 2), often communicating with pericholecystic collections or surrounded by hyperechoic mesenteric reactions [37,38]. Additionally, US can be useful in differentiating gallbladder empyema, emphysematous cholecystitis, and a phlegmonous reaction or pericholecystic abscesses [1,39,40]. Second-level imaging techniques (CT and MRI) are indicated in case of a doubtful diagnosis or to confirm suspected complications of AC.…”