Tumefactive biliary sludge: A sonographic pseudotumour appearance in the common bile duct

Kelly, Ian; Lees, W. R.; Russell, R. C. G.

doi:10.1016/s0009-9260(05)81132-8

Cited by 8 publications

(4 citation statements)

References 19 publications

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“…The clinical relevance of gallbladder sludge has been well established, as has its association with colicky pain, cholecystitis, cholangitis, and acute pancreatitis. The epidemiology, prevalence, and clinical importance of tumefactive sludge, however, remain unclear (11)(12)(13). In clinical practice, when tumefactive sludge is incidentally detected at US examination, observation, short-term follow-up with US, or further evaluation with additional imaging modalities usually is performed.…”

Section: Discussionmentioning

confidence: 99%

Tumefactive Gallbladder Sludge at US:Prevalence and Clinical Importance

et al. 2017

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Purpose To evaluate the prevalence of tumefactive sludge of the gallbladder detected at ultrasonography (US) and to assess whether any clinical and imaging differences exist between benign and malignant tumefactive sludge. Materials and Methods The institutional review board approved this retrospective study. The requirement for informed consent was waived. The study included a cohort (n = 6898) of patients with gallbladder sludge drawn from all adults (n = 115 178) who underwent abdominal US between March 2001 and March 2015. Tumefactive sludge was identified according to the following US findings: (a) nonmovable mass-like lesion and (b) absence of posterior acoustic shadowing at B-mode US and vascularity at color Doppler US. Follow-up examinations were arranged to ascertain whether the results showed true sludge or gallbladder cancer. Risk factors for malignant tumefactive sludge based on clinical and US characteristics were identified with multivariate logistic regression analysis. Results The prevalence of gallbladder and tumefactive sludge at abdominal US during the observation period was 6.0% (6898 of 115 178) and 0.1% (135 of 115 178), respectively. Twenty-eight (20.7%) patients were lost to follow-up. Of the 107 with tumefactive sludge, 15 (14%) were confirmed to have malignant tumefactive sludge. The risk factors for malignant tumefactive sludge were old age (odds ratio [OR], 1.06; P = .035), female sex (OR, 5.48; P = .014), and absence of hyperechoic spots within the sludge (OR, 6.78; P = .008). Conclusion Although the prevalence of tumefactive sludge at US was rare, a considerable proportion of patients had a malignancy. Careful follow-up is essential, especially for older patients, women, and those with an absence of hyperechoic spots at US. RSNA, 2016 Online supplemental material is available for this article.

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Section: Discussionmentioning

confidence: 99%

Tumefactive Gallbladder Sludge at US:Prevalence and Clinical Importance

et al. 2017

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“…It is essentially diagnosed by ultrasonography, and it may play a pathogenic role in the etiology of biliary colic pain and acute pancreatitis. [ 3 ] Characteristically, biliary sludge produces nonshadowing low-amplitude echoes that tend to layer in the most dependent part of the GB because of its high specific gravity and forms a fluid–fluid level that moves very slowly when the patient changes positions. [ 2 ] Artifactual side lobe echoes from adjacent structures are often noted in the GB lumen where they can be mistaken for sludge or calculi.…”

Section: Discussionmentioning

confidence: 99%

“…[ 1 ] Layering of the more dependent parts of the biliary tree occurs because of its higher specific gravity, and this produces a horizontal sludge-bile interface. [ 3 ] The sludge also moves very slowly when changing position, and this is not always detected on real-time imaging. [ 4 ] The first ultrasonographic examination of the present case showed the typical pictures of sludge as described above.…”

Section: Discussionmentioning

confidence: 99%

Tumefactive sludge mimicking gallbladder neoplasm: A case report and review of the literature

et al. 2018

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Biliary sludge (or very thick bile) is mainly comprised of calcium bilirubinate granules and lesser amounts of cholesterol crystals, and it can produce a layer of low amplitude of echoes in the most dependent part of the gallbladder (GB). In tumefactive biliary sludge, low-amplitude echoes do not form a fluid–fluid level but instead tend to give the appearance of a polypoid mass that is bounded by a smooth margin, round, and lobulated. Differential diagnoses for an echogenic mass in the GB lumen include GB carcinoma, tumefactive sludge, and gangrenous cholecystitis. In this case report, we describe a rare case in which biliary sludge did not form a fluid–fluid level but tended to accumulate and appear as a polypoid mass within the lumen of the GB. The lesion was finally identified as being tumefactive sludge mimicking neoplasm of the GB.

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“…In contrast, the relationship of bile duct crystals to sphincter of Oddi dysfunction is not clear (Rhee and Elta 2003). In some patients, sludge in the gallbladder or the common bile duct causes pseudotumorous masses, the so-called tumefactive sludge (Ando and Ito 1986;Kelly et al 1993).…”

Section: Clinical Features Of Sludgementioning

confidence: 99%