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Optimization of diagnostic ultrasonography of the gallbladder based on own experience and literature

Andrzej Smereczyński
Andrzej Smereczyński
, 
Katarzyna Kołaczyk
Katarzyna Kołaczyk
 and 
Elżbieta Bernatowicz
Elżbieta Bernatowicz
   | Mar 31, 2020
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Article Category: review-article
Published Online: Mar 31, 2020
Page range: 29 - 35
Received: Sep 06, 2019
Accepted: Nov 13, 2019
DOI: https://doi.org/10.15557/jou.2020.0006
Keywords
© 2021 Polish Ultrasound Society. Published by Medical Communications Sp. z o.o.
This work is licensed under the Creative Commons Attribution-NonCommercial-NoDerivatives 3.0 License.

Fig. 1.

An entire gallbladder is clearly visible in two cross-sections due to hepatic acoustic window for all its parts
An entire gallbladder is clearly visible in two cross-sections due to hepatic acoustic window for all its parts

Fig. 2.

Two oblique cross-sections of the gallbladder. Its walls may be assessed only when contacting the liver. Gas in the duodenal bulb causes distinct reflections, which make it impossible to assess the gallbladder wall at this site
Two oblique cross-sections of the gallbladder. Its walls may be assessed only when contacting the liver. Gas in the duodenal bulb causes distinct reflections, which make it impossible to assess the gallbladder wall at this site

Fig. 3.

The arrow indicates the gallbladder fundus, which is difficult to assess as it is not covered by the liver
The arrow indicates the gallbladder fundus, which is difficult to assess as it is not covered by the liver

Fig. 4.

Gallbladder. A. Two typical cross-sections, with no detectable lesions. B. The same case. Focusing on the assessment of the gallbladder fundus allowed to identify signs of focal adenomyomatosis
Gallbladder. A. Two typical cross-sections, with no detectable lesions. B. The same case. Focusing on the assessment of the gallbladder fundus allowed to identify signs of focal adenomyomatosis

Fig. 5.

An image of adenomyomatosis in the gallbladder fundus, obtained with a linear transducer. The arrows point to the Rokitansky-Aschoff sinuses
An image of adenomyomatosis in the gallbladder fundus, obtained with a linear transducer. The arrows point to the Rokitansky-Aschoff sinuses

Fig. 6.

Another example of adenomyomatosis in the gallbladder fundus visualized with a linear transducer. The Rokitansky-Aschoff sinuses are clearly seen
Another example of adenomyomatosis in the gallbladder fundus visualized with a linear transducer. The Rokitansky-Aschoff sinuses are clearly seen

Fig. 7.

The arrows indicate a small stone wedged in the neck of the gallbladder, which is difficult to visualize, on two cross-sections
The arrows indicate a small stone wedged in the neck of the gallbladder, which is difficult to visualize, on two cross-sections

Fig. 8.

A long (40 mm), bent cystic duct is seen on the sonogram
A long (40 mm), bent cystic duct is seen on the sonogram

Fig. 9.

Difficult gallbladder assessment due to its horizontal position at the level of the costal arch
Difficult gallbladder assessment due to its horizontal position at the level of the costal arch

Fig. 10.

Divided sonogram. The arrow on the left points to a pseudotumor of the gallbladder fundus due to duodenal bulb compression. After a while the entire gallbladder fundus was visible, as can be seen on the right side of the image
Divided sonogram. The arrow on the left points to a pseudotumor of the gallbladder fundus due to duodenal bulb compression. After a while the entire gallbladder fundus was visible, as can be seen on the right side of the image

Fig. 11.

Divided sonogram. The left-sided arrow indicates a lesion generating dirty shadow in the field of the gallbladder fundus. A segment of transverse colon with accentuated haustration (arrows), which is the cause of this acoustic phenomenon, is seen on the right side of sonogram
Divided sonogram. The left-sided arrow indicates a lesion generating dirty shadow in the field of the gallbladder fundus. A segment of transverse colon with accentuated haustration (arrows), which is the cause of this acoustic phenomenon, is seen on the right side of sonogram

Fig. 12.

The measurement of the actual gallbladder wall thickness is only possible on the hepatic wall
The measurement of the actual gallbladder wall thickness is only possible on the hepatic wall

Fig. 13.

Divided sonogram. A non-enlarged image of a polyp is seen on the left. The same polyp in a zoomed image on the right. The difference is the size is 1.5 mm
Divided sonogram. A non-enlarged image of a polyp is seen on the left. The same polyp in a zoomed image on the right. The difference is the size is 1.5 mm

Fig. 14.

Divided sonogram. The dimensions of the same polyp in a non-zoomed image on the left and in a zoomed image on the right
Divided sonogram. The dimensions of the same polyp in a non-zoomed image on the left and in a zoomed image on the right

Fig. 15.

Divided sonogram. Accurate assessment of shape and size of a gallbladder adenoma (right) is possible only using an enlarged image
Divided sonogram. Accurate assessment of shape and size of a gallbladder adenoma (right) is possible only using an enlarged image

Fig. 16.

Gallbladder. A. An image obtained in two oblique projections in supine position. Stones cannot be seen in these projections. B. The same gallbladder. Microstones were observed only in the right oblique position
Gallbladder. A. An image obtained in two oblique projections in supine position. Stones cannot be seen in these projections. B. The same gallbladder. Microstones were observed only in the right oblique position

Fig. 17.

Variable location of gallbladder microstones in a supine and upright position
Variable location of gallbladder microstones in a supine and upright position

Fig. 18.

A floating gallbladder with a stone. A. In a supine position, the gallbladder (GB) is located to the left of the aorta (A). S – Spine. B. The same gallbladder in the position on the right side. The gallbladder (GB) migrated to the right of the aorta (A)
A floating gallbladder with a stone. A. In a supine position, the gallbladder (GB) is located to the left of the aorta (A). S – Spine. B. The same gallbladder in the position on the right side. The gallbladder (GB) migrated to the right of the aorta (A)

Fig. 19.

Divided sonogram. Size and vascular pattern of a gallbladder adenoma
Divided sonogram. Size and vascular pattern of a gallbladder adenoma

Fig. 20.

Divided sonogram. Vascularized gallbladder cancer mimicking a mass of biliary sludge
Divided sonogram. Vascularized gallbladder cancer mimicking a mass of biliary sludge

Fig. 21.

A. Portal vein thrombosis in cirrhosis. Gallbladder wall blood vessels were visualized with Color Doppler. B. Pulsed Wave Doppler showed venous blood flow in these vessels
A. Portal vein thrombosis in cirrhosis. Gallbladder wall blood vessels were visualized with Color Doppler. B. Pulsed Wave Doppler showed venous blood flow in these vessels
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