Findings: Ultrasound evaluation of the abdomen demonstrates a small gallbladder with diffusely thickened wall and adjacent fixed small soft tissue polyps. There was no biliary ductal dilatation or shadowing echogenic stones within the gallbladder.
Diagnosis: Chronic cholecystitis with gallbladder polyps.
Discussion: Chronic inflammation of the gallbladder results from recurrent attacks of acute cholecystitis. Fibrotic reaction usually causes the gallbladder to become small and contracted.
The most frequent gallbladder wall abnormality detected by ultrasound is diffuse wall thickening, which is diagnosed when the wall is greater than 3 mm thick. Diffuse wall thickening is nonspecific and this appearance is neither sensitive nor specific for an inflammatory process. Approximately 50 to 75% of patients with acute cholecystitis have diffusely thickened gallbladder walls, whereas 25% of patients with chronic cholecystitis have this finding.
Other conditions associated with diffuse gallbladder wall thickening include hepatic dysfunction (hypoalbuminemia, ascites and hepatitis), congestive heart failure, renal disease, AIDS and sepsis.
References:
Eisenberg RL. Ultrasound Atlas of Disease Processes.
Appleton and Lange, Norwalk; 1993:64-64.
Kurtz AB. Ultrasound, The Requisites. Mosby, St. Louis; 1996:49-50.
Rumack CM. Diagnostic Ultrasound, 2nd Edition. Mosby, St. Louis; 1998:180-181.
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