Ss 141 Examination

Scan Planes n Right subcostal oblique scan (see p. 22) n Intercostal scan, extended intercostal scan (see p. 23)

n The gallbladder nestles in the gallbladder fossa on the visceral surface of the liver, with only its fundus projecting past the inferior hepatic surface. n The gallbladder is bounded on the right side by the right lobe of the liver, on the left side by the quadrate lobe, and posteriorly by the antrum or duodenal bulb (Fig. 474a, p. 323, and Fig. 474b, p. 323). n Although many variants may be encountered (e.g., spherical, oblong, serpentine), the "textbook" gallbladder is pear-shaped and displays typical cystic features on ultrasound (anechoic interior, distal acoustic enhancement, smooth margins). n Normal dimensions: longitudinal diameter < 100 mm, transverse diameter < 40 mm; volume < 100 mL, wall thickness < 3 mm (Fig. 488).

Gallbladder Enhancement Ultrasound
Fig. 488a-d Sonographic appearance of the gallbladder and its dimensions (cursors; length and depth in a, width in b). a Intercostal scan. b Right subcostal oblique scan. GB = gallbladder, L = liver

n Transducer: 3.5-5.0 MHz n Patients are generally examined in a fasting state.

n The patient is usually positioned supine, or occasionally in left lateral decubitus or a standing position ("rolling stones," polyps). n The patient can be rapidly turned to mobilize crystal aggregates and microliths, causing them to swirl within the gallbladder lumen. n The examination includes digital palpation (Murphy's sign of acute cholecystitis

= pain on gallbladder compression). n Intercostal scans are helpful in patients with an elevated hemidiaphragm, in heavy-set patients, and after surgical operations.

n Classification: Gallbladder abnormalities seen on ultrasound are classified as changes of size, shape, or location; intraluminal changes; and wall changes.

• Change in gallbladder size: This may have a functional or organic cause.

• Intraluminal and wall changes: It is important to distinguish between intraluminal and wall changes because of their different therapeutic implications. When wall changes are found, it is essential to make a detailed evaluation with magnified views and to document the findings in multiple planes (to determine whether operative treatment is indicated).

n Overview:

• Changes in size, shape, and location: see Table 57, p. 335.

• Intraluminal changes: see Table 59, p. 364.

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