Image Based Questions On Gall Bladder And Bile Duct

Diagnosis – Phrygian Cap

M/C congenital anomaly of gall bladder · Characterized by infoldings of septum between body and fundus of gall bladder · Functions of gall bladder are normal. So not an indication for cholecystectomy.

Different Type of Gall Stones 

Yellow colored →Cholesterol gall stone · Black colored →Pigmented stones · Brown colored →Pigmented stones · M/C type of gall stone worldwide → Mixed > Cholesterol stone · M/C type in Asian population → Pigmented stones (i.e. combined incidence of black and brown stone) · Gall stone shows Tri-radiate fissure on Radiological investigations due to trapped air k/a Mercedes Benz sign · If Bi-radiate fissure is present k/a Seagull sign · IOC for gall bladder stones is USG.

Hyper echoic structure in the lumen with posterior acoustic shadow on USG suggesting gall stone.

Hyper echoic structure in lumen without posterior acoustic shadow on USG suggesting gall bladder polyp · IOC for diagnosis - Gallstones →USG . Acute Cholecystitis →USG . Acute Calculous Cholecystitis →USG . Chronic Cholecystitis →USG · Gold standard investigation for Acute Cholecystitis → HIDA scan.

Normal HIDA scan - Tracer in gall bladder, CBD and small bowel. In acute Cholecystitis.- No filling of GB tracer in CBD and small bowel.

Non visualization of GB in HIDA scan is diagnostic.

Emphysematous Cholecystitis

M/C organism responsible for o Emphysematous Cholecystitis →Cl. Perfringens > E. Coli o Emphysematous Pyelonephritis → E. coli o Xanthogranulomatous Pyelonephritis →Proteus o Xanthogranulomatous Cholecystitis → Rupture of Rokitansky-Asch off sinus · M/C aerobic organism responsible for emphysematous Cholecystitis → E. Coli · IOC for Emphysematous Cholecystitis →CECT.

CT finding →Gas within GB wall along with air fluid level.

Diagnosis: Adenomyomatosis 

 In Adenomyomatosis there is hyperplastic changes in muscularis with mucosal hyperproliferation because of which there are deep Rokitansky – Asch off sinuses with deposition of cholesterol crystals · USG shows Diamond ring sign / Comet tail artifact / Vshaped artifact.

Diagnosis: Calcified Gall bladder or Porcelain gall bladder 

 In this condition there is extensive calcium encrustation in wall of GB · It is a risk factor for carcinoma GB so early laparoscopic cholecystectomy is done.

Diagnosis: Strawberry GB / Cholesterolosis 

Deposition of cholesterol ester and triglycerides in the epithelial macrophages of GB wall · Associated with Hypercholesterolemia · Can see Cholesterol stones and Cholesterol polyp · Acquired condition.

Diagnosis: Polyp Arising From Fundus of Gall Bladder 

IOC is ultrasound · USG shows presence of hyper echoic structure in the lumen without posterior acoustic shadowing.

Diagnosis: Caroli's disease 

CECT shows Central dot sign suggesting Caroli's disease · Caroli's disease is Type V choledochal cyst in which there is involvement of only intrahepatic bile duct · TOC: Liver transplantation · CECT shows dilated intra hepatic bile duct and dilated portal vein radicals. This appearance is k/a Central dot sign.

Also read: High-Yield GIT, Hepatobiliary and Pancreatic Surgery Questions

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