Ultrasonic Scanning in the Diagnosis of Biliary Disease

Leopold, George R.; Sokoloff, Joel

doi:10.1016/s0039-6109(16)40133-7

Cited by 38 publications

(6 citation statements)

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“…Whether the stones contain calcium seems to have little to do with ultrasonographic detectability [5]. A reproducible shadow behind an echo that is situated in the gallbladder lumen is convincing evidence that a gallstone is present.…”

Section: Discussionmentioning

confidence: 99%

“…The gallbladder that is not demonstrated by this technique may be small in size (less than 2.5 cm) [2], have an unusual shape or location, i.e., sharply angulated or situated high under the rib cage, or contain small stones that produce internal echoes which may render the gallbladder invisible against the background of echoes in surrounding tissue [2][3][4]. It has been suggested that nondemonstration of the gallbladder helps only to exclude the presence of an enlarged gallbladder [5].We recently encountered eight patients in whom cholelithiasis was correctly diagnosed ultrasonographically, despite the lack of demonstration of the gallbladder. The following two cases are selected to illustrate the observed findings.…”

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confidence: 99%

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Gallstones preventing ultrasonographic visualization of the gallbladder

Laing

Gooding

Herzog

1976

Gastrointest Radiol

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Abstract. Ultrasonography can be used to diagnose the presence of multiple gallstones, despite the fact that the gallbladder, per se, may not be demonstrated. The finding of many echoes in the area occupied by the gallbladder that cast a large acoustical shadow is strongly suggestive of gallstones.Key words: UltrasonographyGallstones --Oral cholecystography.Ultrasonography has proved successful in demonstrating the gallbladder in 80 to 92% of fasting patients [1][2][3]. The gallbladder that is not demonstrated by this technique may be small in size (less than 2.5 cm) [2], have an unusual shape or location, i.e., sharply angulated or situated high under the rib cage, or contain small stones that produce internal echoes which may render the gallbladder invisible against the background of echoes in surrounding tissue [2][3][4]. It has been suggested that nondemonstration of the gallbladder helps only to exclude the presence of an enlarged gallbladder [5].We recently encountered eight patients in whom cholelithiasis was correctly diagnosed ultrasonographically, despite the lack of demonstration of the gallbladder. The following two cases are selected to illustrate the observed findings.by the ingestion of fatty foods. Several members of her family had had gallstones. She had had no jaundice, dark urine, or clay-colored stools. Physical examination was unremarkable and results of laboratory studies, including liver function tests, were within normal limits.Ultrasonographic examination of the right upper quadrant disclosed a number of echoes embedded in the medial surface of the inferior aspect of the right lobe of the liver. Behind the echoproducing region was a large acoustical shadow, easily reproducible on both longitudinal and transverse scans (Fig, 1A and B).An oral cholecystogram confirmed the impression of multiple small stones within the gallbladder (Fig. 1 C). Case 2A 58-year-old man was evaluated because of tenderness in the right upper quadrant of his abdomen. Ultrasonography showed a prominent acoustical shadow that was situated posterior to a grouping of strong echoes in the region of the gallbladder fossa ( Fig. 2A). Oral cholecystography demonstrated a single, calcified gallstone in a septated gallbladder (Fig. 2B). This finding was confirmed surgically. Comment."The remaining six patients demonstrated similar ultrasonographic findings. In all cases a prominent acoustical shadow was seen posterior to a strong grouping of echoes located in the anatomic region of the gallbladder fossa. Multiple small gallstones which completely filled the gallbladder were present at the time of surgery or on subsequent radiographic studies in each case. Case Reports DiscussionBecause gallstones strongly reflect sonic emissions, sound waves are rapidly attenuated and create an acoustical "shadow." Whether the stones contain calcium seems to have little to do with ultrasonographic detectability [5]. A reproducible shadow behind an echo that is situated in the gallbladder lumen is convincing evidence that a gallstone is pre...

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Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

Gallstones preventing ultrasonographic visualization of the gallbladder

Laing

Gooding

Herzog

1976

Gastrointest Radiol

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“…The technique was similar to that described by Doust & Maklad [11], Leopold & Sokoloff [12], and Hassani [13]. A standard commercially available ultrasound scanner was employed, with gray scale unit and 13 and 19 mm focused transducers with frequencies of 2.25 and 3.5 MHz.…”

Section: Methodsmentioning

confidence: 99%

Infusion tomography and ultrasonography of the gallbladder in the diagnosis of acute cholecystitis

Karp

Herlin

Holmin

et al. 1979

Gastrointest Radiol

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Sixty-three patients with the clinical suspicion of acute cholecystitis were examined with infusion tomography of the gallbladder. Ultrasonography was performed in 51 of these cases. The technique and diagnostic principles of both methods are discussed. The diagnostic value of the two methods when used in combination is stressed. Thus in a case of gangrenous cholecystitis when opacification of the gallbladder wall may not appear at infusion tomography, ultrasonography may demonstrate signs of gallbladder disease. Infusion tomography, on the other hand, may be of great value if ultrasonography is not informative.In acute cholecystitis there is reason to believe that surgical intervention should be carried out as early as possible in order to reduce mortality [1-4]. The need for rapid and reliable diagnostic methods is therefore obvious. If the patient has a history of repeated attacks of biliary colic and is admitted to the hospital with fever, pain, and tenderness localized in the right upper quadrant of the abdomen, the diagnosis of acute cholecystitis is likely, at least if earlier cholecystography has proved the presence of cholelithiasis and/or nonfunctioning gallbladder. In such instances, there is seldom need for further diagnostic considerations before operative intervention. However, many patients with acute cholecystitis have no history of abdominal pain and the clinical diagnosis is not firm enough to indicate an acute operation.

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“…Si varied, but a diameter of more than 4cm appeared to be abnormal. (Leopold, 1973 . ) In cholelithiasis, the stones were seen as dense shadows within the gallbladder.…”

Section: Introductionmentioning

confidence: 99%

Ultrasound in the Investigation of Biliary Tract Disease

Sommerville

1978

Australas Radiol

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SUMMARY 88 patients with non‐opacification of the gallbladder were examined by Ultrasound of the right upper quadrant of the abdomen. Criteria for the diagnosis of gallstones are described. Employing such criteria we have had no false positive results in the diagnosis of calculi. Our overall accuracy rate has been 90% and we feel that this has been improved in examinations after this analysis was completed by expanding our criteria to include stones and their acoustic “shadow”, even when the gallbladder itself cannot be demonstrated. Thirty‐three patients with jaundice were examined by Ultrasonography as an initial procedure, not only because of its accuracy, as shown by our figures, but also because it is a safe, noninvasive technique. Criteria for the diagnosis of obstructive jaundice are described. In those patients with obstructive jaundice caused by pancreatic disease, enlargement of the pancreas was successfully shown. In patients with hepatocellular jaundice, causes such as liver metastases, cirrhosis and Congestive Heart Failure were accurately diagnosed.

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Ultrasonic Scanning in the Diagnosis of Biliary Disease

Cited by 38 publications

References 5 publications

Gallstones preventing ultrasonographic visualization of the gallbladder

Gallstones preventing ultrasonographic visualization of the gallbladder

Infusion tomography and ultrasonography of the gallbladder in the diagnosis of acute cholecystitis

Ultrasound in the Investigation of Biliary Tract Disease

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