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Imaging of Biliary Colic and Cholecystitis

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Pain Imaging

Abstract

Cholelithiasis and cholecystitis represent common causes of upper abdominal pain in adult population. Imaging of the gallbladder has changed dramatically in recent decades; US still represents the method of choice for detection of gallstones for its high sensitivity and wide availability; however, CT and MR can allow an accurate, noninvasive imaging especially in patients with severe symptoms and suspected complications.

The characteristic US finding of gallstones is a highly reflective echo from the anterior surface of gallstones with a marked posterior acoustic shadowing.

CT is less sensitive than US in the detection of stones but is better able to demonstrate severe complications of acute cholecystitis.

MRI, including MR cholangiopancreatography (MRCP), can be a valuable complement in patients with severe symptoms, especially when US and CT findings are inconclusive, allowing a detailed evaluation of the biliary tract with the advantages of improved stone detection and absence of ionizing radiation.

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Authors and Affiliations

  1. Department of Radiology, Università Cattolica del Sacro Cuore, Rome, Italy

    Bordonaro Veronica, Carchesio Francesca, Larosa Luigi, Anna Maria De Gaetano & Manfredi Riccardo

Authors
  1. Bordonaro Veronica
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  2. Carchesio Francesca
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  3. Larosa Luigi
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  4. Anna Maria De Gaetano
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  5. Manfredi Riccardo
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Corresponding author

Correspondence to Manfredi Riccardo .

Editor information

Editors and Affiliations

  1. Department of Radiology, Cattinara Hospital, University of Trieste, Trieste, Italy

    Maria Assunta Cova

  2. Department of Radiology, Maggiore Hospital, Trieste, Italy

    Fulvio Stacul

13.1 Electronic Supplementary Material

Contrast-enhanced CT images show a voluminous mixed gallstone consisting in hypodense core and calcified shell with tiny peripheral gas collections. (MP4 23024 kb)

A 66-year-old woman with choledocholithiasis. CT images show hyperdense sludge within the iuxtapapillary choledochus. (MP4 10853 kb)

MR images show a distended gallbladder with several small stones layered in the lumen. The main bile duct and intrahepatic branches are dilated, but non-stones are clearly present in the lumen. (MP4 1816 kb)

MR images show a distended gallbladder with several small stones layered in the lumen. The main bile duct and intrahepatic branches are dilated, but non-stones are clearly present in the lumen. (MP4 941 kb)

Choledocholithiasis. MR images show multiple filling defects in the CBD, related to numerous calculi. (MP4 2822 kb)

Choledocholithiasis. MR images show multiple filling defects in the CBD, related to numerous calculi. (MP4 1500 kb)

Choledocholithiasis with acute cholangitis, gallbladder perforation, and hepatic abscess. Obstructive gallstones in the distal CBD with marked proximal intra- and extrahepatic biliary ductal dilatation and a hydropic gallbladder with dependent stones, focal disruptions of the wall, and multiple loculated pericholecystic fluid collections. In left liver lobe also an intrahepatic abscess is demonstrated. (MP4 12027 kb)

Contrast-enhanced CT images show a diffuse pancreatic swelling with peripancreatic and retroperitoneal edema and fat stranding, extending to the pararenal space (thickened Gerota’s fascia). Small calcified gallstones are present into the gallbladder lumen. (MP4 9960 kb)

Acute cholecystitis in a 51-year-old man with upper abdominal pain and fever, already treated by cholecystostomy. Contrastenhanced CT image show a gallbladder wall thickening, with intense mucosal enhancement and hypoattenuating submucosal edema. (MP4 14998 kb)

T1 MR image before and after gadolinium administration in a 61-year-old man with persistent jaundice and biliary stent implantation. Gallbladder appears over-distended with a hyper-enhanced wall thickening and an intraluminal air-fluid level with hyperintense small stones in dependent position. (MP4 17923 kb)

Emphysematous cholecystitis in an 86-year-old woman with upper abdominal pain and fever. Contrast-enhanced CT images show an over-distended gallbladder and an important wall thickening with intraluminal and intramural air. (MP4 8816 kb)

Emphysematous cholecystitis in an 86-year-old woman. MR images show a marked gallbladder wall thickening with intense contrast enhancement. Inhomogeneous intraluminal material and void of signal areas due to air bubbles are also detected. (MP4 1093 kb)

Emphysematous cholecystitis in an 86-year-old woman. MR images show a marked gallbladder wall thickening with intense contrast enhancement. Inhomogeneous intraluminal material and void of signal areas due to air bubbles are also detected. (MP4 1516 kb)

Emphysematous cholecystitis in an 86-year-old woman. MR images show a marked gallbladder wall thickening with intense contrast enhancement. Inhomogeneous intraluminal material and void of signal areas due to air bubbles are also detected. (MP4 14876 kb)

Gangrenous cholecystitis in a 64-year-old woman with leukocytosis and abdominal pain and a clinical history of pancreatic adenocarcinoma. Contrast-enhanced CT images show gallbladder wall thickening with focal mucosal defects without frank perforation and pericholecystic inflammation with multiple loculated fluid collections. (MP4 4396 kb)

Acute suppurative cholecystitis in a diabetic patient with abdominal pain and fever. CT images show a distended gallbladder with moderate hypodense wall thickening and intraluminal high-attenuating corpusculated material resembling sludge. (MP4 19822 kb)

Acute suppurative cholecystitis in a diabetic patient with abdominal pain and fever. The MR images performed 1 week later show gallbladder wall fissurations with multiple pericholecystic fluid collections. (MP4 2747 kb)

Acute suppurative cholecystitis in a diabetic patient with abdominal pain and fever. The MR images performed 1 week later show gallbladder wall fissurations with multiple pericholecystic fluid collections. (MP4 2429 kb)

Gallbladder perforation with an entero-biliary fistula in a 73-year-old woman with abdominal pain and high fever. Contrastenhanced CT images show a collapsed gallbladder with an irregular wall thickening and inhomogeneous intense enhancement and a fistulous communication between the gallbladder wall and duodenum. CT images also show dilated loops of small bowel up to the level of an obstructive gallstone, with hyperdense calcific core and a radiolucent peripheral component. (MP4 23740 kb)

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Veronica, B., Francesca, C., Luigi, L., De Gaetano, A.M., Riccardo, M. (2019). Imaging of Biliary Colic and Cholecystitis. In: Cova, M., Stacul, F. (eds) Pain Imaging. Springer, Cham. https://doi.org/10.1007/978-3-319-99822-0_13

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  • DOI: https://doi.org/10.1007/978-3-319-99822-0_13

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