Diagnostic approach through imaging in benign gallbladder and bile ducts pathology

Gaspar Alberto Motta Ramírez; Carlos Rodríguez Treviño

2010, Number 2

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Rev Mex Cir Endoscop 2010; 11 (2)

Diagnostic approach through imaging in benign gallbladder and bile ducts pathology

Motta RGA, Rodríguez TC

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Language: Spanish
References: 21
Page: 71-79
PDF size: 557.20 Kb.

ABSTRACT

Ultrasound (US) is the recommended initial imaging test in the evaluation of patients presenting with jaundice or right upper quadrant pain because of ultrasound’s multi-organ imaging capabilities and because of its ability to localize areas of maximum tenderness. Dependent upon clinical circumstances, the differential diagnosis includes cholecystitis, choledocholithiasis, or tumor. US is very sensitive in detection of mechanical biliary obstruction and stone disease, although less sensitive for detection of obstructing tumors, including pancreatic carcinoma and cholangiocarcinoma. In patients with US documented cholelithiasis and choledocholithiasis, laparoscopic cholecystectomy with operative clearance of the biliary stone disease is usually performed. In patients with clinically suspected biliary stone disease, without initial US documentation of choledocholithiasis, endoscopic US or magnetic resonance cholangiopancreatography is the next logical imaging step. The diagnosis of acute cholecystitis can be confirmed if calculi are visualized within a focally tender gallbladder. This diagnosis is further supported if the gallbladder contains sludge and a thickened wall. If the gallbladder contains calculi, but the patient’s tenderness is not well localized over the gallbladder, the patient may have chronic cholecystitis, and possibly a more acute process elsewhere.

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