Gallbladder and Biliary Tract: Differential Diagnosis







Gallbladder Imaging




TABLE 82-1

Gallbladder Filling Defects













COMMON



  • Gallstones



  • Sludge



  • Mucosal folds



  • Partial volume artifact (ultrasound, CT)



  • Adenomyomatosis



  • Cholesterolosis



  • Pseudomass-duodenal impression (ultrasound)



  • Air volume averaging with adjacent bowel (CT, MR)

UNCOMMON



  • Carcinoma



  • Metastases, especially melanoma, lung, kidney, esophagus



  • Adenoma



  • Papilloma




  • Villous hyperplasia



  • Epithelial cyst



  • Mucus retention cyst



  • Worms and parasites: Ascaris, Paragonimus, Clonorchis, Filaria, Schistosoma, Fasciola



  • Fibrinous debris



  • Desquamated mucosa



  • Metachromatic leukodystrophy



  • Ectopic pancreatic, gastric, hepatic, intestinal, prostatic tissue



  • Varices



  • Inflammatory polyp



  • Food through enterobiliary fistula



  • Fibroadenoma



  • Neurinoma



  • Hemangioma



TABLE 82-2

Enlarged Gallbladder











COMMON



  • Cystic duct or common bile duct obstruction



  • Hyperalimentation



  • Post surgery



  • Prolonged fasting



  • Vagotomy



  • Diabetes mellitus



  • AIDS



  • Mucocele



  • Empyema



  • Hydrops



  • Hepatitis



  • Pancreatitis



  • Alcoholism



  • Narcotic analgesia



  • Anticholinergics

UNCOMMON



  • Kawasaki’s syndrome



  • Leptospirosis



  • Scarlet fever



  • Acromegaly



TABLE 82-3

Small Gallbladder








  • Chronic cholecystitis



  • Congenital multiseptate gallbladder



  • Postprandial study



  • Cystic fibrosis



  • Congenital hypoplasia



  • Congenital multiseptate gallbladder



  • Hypoplastic gallbladder



TABLE 82-4

Gallbladder Wall Thickening











COMMON



  • Acute cholecystitis



  • Chronic cholecystitis



  • Hyperplastic cholecystosis



  • Hepatitis



  • Portal hypertension



  • Right-sided heart failure



  • Hypoproteinemia or hypoalbuminemia



  • Gallbladder carcinoma



  • Renal failure



  • Total parenteral nutrition



  • Cirrhosis



  • Sepsis



  • Infectious mononucleosis



  • Acute pancreatitis



  • AIDS



  • Postprandial study



  • Pyelonephritis of right kidney

UNCOMMON



  • Sclerosing cholangitis



  • Schistosomiasis



  • Xanthogranulomatous cholecystitis



  • Extrahepatic portal vein obstruction



  • Lymphatic obstruction



  • Gallbladder wall varices



  • Multiple myeloma



  • Lymphoma



  • Obstructed gallbladder lymphatics



  • Acute myelogenous leukemia



  • Brucellosis



  • Graft-versus-host disease



TABLE 82-5

Pericholecystic Fluid








  • Pericholecystic abscess



  • Pancreatitis



  • Acute cholecystitis



  • Pericholecystic abscess



  • Ascites



  • AIDS



  • Peritonitis



TABLE 82-6

Multiseptate Gallbladder








  • Desquamated gallbladder mucosa



  • Congenital malformation



  • Normal folded gallbladder



  • Cholesterolosis



  • Adenomyomatosis



TABLE 82-7

Gas in the Gallbladder or Biliary Tract











COMMON



  • Postoperative (e.g., status post sphincterotomy or Whipple’s procedure)



  • Biliary-enteric fistula (see Table 82-8 )



  • Pancreatitis



  • Emphysematous cholecystitis

UNCOMMON



  • Common duct entry into duodenal diverticulum



  • Crohn’s disease



  • Incompetent sphincter



  • Carcinoma of the gallbladder, ampulla, duodenum, bile ducts, stomach, colon



  • Metastases



  • Lymphoma



  • Trauma



  • Status post intubation or ERCP



  • Parasites: Strongyloides, Clonorchis, Ascaris, ruptured amebic abscess of liver



TABLE 82-8

Cholecystenteric and Biliary-Enteric Fistula











COMMON



  • Gallstone fistula from gallbladder or bile ducts



  • Postoperative (e.g., Whipple’s procedure)

UNCOMMON



  • Carcinoma of the gallbladder, bile ducts, duodenum, colon, stomach



  • Peptic ulcer perforation into biliary tract



  • Crohn’s disease



  • Diverticulitis of the duodenum or hepatic flexure



  • Actinomycosis



  • Tuberculosis



  • Trauma



  • Lymphoma



  • Perforating cholecystitis





Ultrasound




TABLE 82-9

Focal, Mobile, Shadowing Gallbladder Reflectors








  • Gallstones



  • Intraluminal gas



  • Calcified parasites: Ascaris, Clonorchis, Fasciola



TABLE 82-10

Focal, Mobile, Nonshadowing Gallbladder Reflectors








  • Small stones not in transducer focal zone



  • Blood clots



  • Pus



  • Sludge balls



  • Parasites: Ascaris, Clonorchis, Fasciola



  • Precipitated contrast material from ERCP



  • Fibrinous debris



  • Desquamated mucosa



TABLE 82-11

Focal, Nonmobile, Shadowing Gallbladder Reflectors








  • Stone or crystal in Rokitansky-Aschoff sinus



  • Impacted gallstone



  • Spiral valve folds



  • Polyp-containing cholesterol



  • Adherent gallstone


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Jun 23, 2019 | Posted by in GASTROINTESTINAL IMAGING | Comments Off on Gallbladder and Biliary Tract: Differential Diagnosis

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