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SMALL PORCELAIN GALLBLADDER IMAGING
Category: Diagnostic Radiology
Abstract : THE CONTRACTED OR SMALL GALLBLADDER Postprandial The most likely cause is physiological and due to inadequate preparation. The normal gallbladder wall is thickened when contracted, and this must not be confused with a pathological process. Always enquire what the patient has recently eaten or drunk. Pathological causes of a small gallbladder Most pathologically contracted gallbladd
THE CONTRACTED OR SMALL GALLBLADDER
Postprandial
The most likely cause is physiological and due to inadequate preparation. The normal gallbladder wall is thickened when contracted, and this must not be confused with a pathological process. Always enquire what the patient has recently eaten or drunk.
Pathological causes of a small gallbladder
Most pathologically contracted gallbladders contain stones.
When the gallbladder cannot be identified, try scanning transversely through the gallbladder fossa, just caudal to the porta hepatis. Strong shadowing alerts the sonographer to the possibility of a contracted gallbladder full of stones. The reflective surface of the stones and distal shadowing are apparent and the anterior gallbladder wall can be demonstrated with correct focusing and good technique. Do not confuse the appearances of a previous cholecystectomy, when bowel in the gallbladder fossa casts a shadow, with a contracted, stone-filled gallbladder.
A less common cause of a small gallbladder is the microgallbladder associated with cystic fibrosis. The gallbladder itself is abnormally small, rather than just contracted. Cystic fibrosis also carries an increased incidence of gallstones because of the altered composition of the bile and bile stasis and the wall might be thickened and fibrosed from cholecystitis.
PORCELAIN GALLBLADDER
When the gallbladder wall becomes calcified the resulting appearance is of a solid reflective structure causing a distal shadow in the gallbladder fossa. This can be distinguished from a gallbladder full of stones where the wall can usually be seen anterior to the shadowing. A porcelain gallbladder probably results from a gallbladder mucocoele a long-standing obstruction of the cystic duct, usually from a stone. The bile inside the non-functioning gallbladder is gradually replaced by watery fluid, the wall becomes fibrotic and thickened and ultimately calcifies. There is an association between porcelain gallbladder and gallbladder carcinoma, so a prophylactic cholecystectomy is usually performed to pre-empt malignant development. The shadowing from the anterior gallbladder wall obscures the gallbladder contents, and can mimic bowel in the gallbladder fossa. A plain X-ray also clearly demonstrates the porcelain gallbladder.
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