Ultrasound Diagnosis of Benign Gallbladder Hemorrhage

Abstract

The sonographic diagnosis of hemobilia is rare. Once this entity is recognized sonographically, its etiology must be determined. The characteristic sonographic appearance of gallbladder hemorrhage is described.The most common echogenic foci within the gallbladder are calculi, and they possess characteristic sonographic features of mobility and posterior acoustic shadowing. I Echogenic masses that do not possess posterior acoustic shadowing within the gallbladder are not uncommon, but usually represent tumefactive sludge, or rarely, empyema. 2~ 3 Gallbladder polyps are echogenic masses that are adherent to the gallbladder wall and do not cause shadowing. Although quite rare, the presence of echogenic debris with septations is characteristic of hemorrhage, and the sonographic diagnosis of hemobilia can be made. Case ReportA right upper quadrant ultrasound examination was performed on a 31-year-old woman with a 1-week history of severe right upper quadrant pain. Images were obtained using an ATL HDI real-time machine (Bothel, WA). The sonogram was remarkable for echogenic debris with septations filling the entire gallbladder lumen (Figs. 1 A,B). The gallbladder was not distended and there was no wall thickening visualized. There was no intra-or extrahepatic biliary dilatation.At the time of examination, it was noted that the patient had several large bruises on her lower extremities. The diagnosis of hemobilia was made, and this finding was discussed with the primary care physician. He ordered a coagulation profile on the patient the next day. Her bleeding time was markedly elevated at 11 minutes (normal range = 1.5-7.5 minutes). Results of further blood tests, including prothrombin time, partial thromboplastin time, and platelet count, were normal.Further clinical questioning revealed that the patient, an active softball player, had played a rigorous game 1 week ago, which coincided with the onset of symptoms. The patient also regularly takes 8 to 12 aspirins per day.