Biliary Lithiasis and Cholecystitis

  • Francis S. Weill


Gallstones have two very different ultrasonographic appearance: in some cases the number of stones is so large that the entire gallbladder is filled with calculi, whereas in others there may be a single or a few calculi free within the bile-filled viscus. I shall begin by examining the second case which is more frequent. There are two types of ultrasonographic signs of calculi that fill the gallbladder incompletely: direct and indirect.


Bile Duct Common Bile Duct Acute Cholecystitis Sagittal Section Gallbladder Wall 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References and Further Reading

  1. Abdurahman KE (1982) Sonographic diagnosis of biliary ascariasis. AJR 139: 485–489PubMedGoogle Scholar
  2. Addison NV (1979) The clinical value of ultrasound in biliary tract and pancreatic disease. Ann R Coll Surg Engl 61:448–451PubMedGoogle Scholar
  3. Allen MJ, Borody TJ, Buglosi TF et al. (1985) Rapid dissolution of gallstones by methyl-tert-butyl-ether - preliminary observations. N Engl J Med 312: 217–220PubMedGoogle Scholar
  4. Bamett E, Moriey P (1974) Abdominal echography. Butter-worths, LondonGoogle Scholar
  5. Baron RL, Stanley RJ, Lee JKT, Koehler RE, Levitt RG (1983) Computed tomographic features of biliary obstruction. AJR 140: 1173–1178PubMedGoogle Scholar
  6. Bartrum RJ (1973) Non utility of ultrasound in acute cholecystitis. Radiology in Baden-Baden, Seminary of the universities of Connecticut and Freiburg/Breisgau, Sept 1983Google Scholar
  7. Bartrum RJ, Crow HC, Foote SR (1977) Ultrasonic and radiographic cholecystography. N Engl J Med 296: 538–541PubMedGoogle Scholar
  8. Becker JC (1971) Contribution à l’étude tomo-échographique des affecrions du foie, des voies biliaires et du pancréas. Thesis, University of Besançon BesançonGoogle Scholar
  9. Becker CD, Burckhardt B, Terrier F (1986) Ultrasound in postoperative acalculous cholecystitis. Gastrointest Radiol 11:47–50PubMedGoogle Scholar
  10. Berger M, Smith E, Holm HH, Mascatello V (1977) Urility of ultrasound in the differential diagnosis of acute chole-cystiris. Arch Surg 112: 273–275PubMedGoogle Scholar
  11. Bergman AB, Neiman HL, Kraut B (1979) Ultrasonic evaluarion of pericholecystic abscesses. AJR 132: 201–203PubMedGoogle Scholar
  12. Birkenfeld L, Otto P (1975) The value of ultrasonic tomography in the diagnosis of the gallbladder (abstract no 95). Second European Congress, Munich. 1975Google Scholar
  13. Blais L, Kunsriinger F, Bokobsa J, Sassoon C, Baussan C, Doyon D (1982) Etude échographique du liquide échogène intra-vésiculaire. Signification pathologique à propos de 74 cas. J Radiol 63: 85–90PubMedGoogle Scholar
  14. Blaquiere RM, Dewbury KC (1982) The ultrasound diagnosis of emphysematous cholecystiris. Br J Radiol 55: 114–116PubMedGoogle Scholar
  15. Block J (1979) Valeur diagnostique comparée de la cholé- cystographie et de l’échographie dans la lithiase vésicu- laire. Communication au Congrès National de la SFAUMB, October 1979, Marseille.Google Scholar
  16. Bolondi L, Gandolfi L, Labo G (1979) Ultrasuoni in gastro-enterologia. Piccin, PaduaGoogle Scholar
  17. Bruneton JN, Drouillard J, Renson M, Roux P, Bourry J, Lecomte P, Tavemier J (1981) Etude cririque des explora- rions complémentaires non biologiques des voies biliaires avant la décision thérapeurique. J Radiol 62: 409–416PubMedGoogle Scholar
  18. Buchenne HJ (1987) The promise of extracorporeal shock- wave lithotripsy for the treatment of gallstones. AJR 149: 233–235Google Scholar
  19. Carroll BA, Oppenheimer DA (1982) Sclerosing cholangiris: sonographic demonstrarion of bile duct wall thickening. AJR 139:1016–1018PubMedGoogle Scholar
  20. Cerri GG, Leite GJ, Simoes JB, Da Rocha DJC, Albuquerquer FP, Machado MCC, Magalhaes A (1983) Ultrasonographic evaluation of ascaris in the biliary tract. Radiology 146: 753–754PubMedGoogle Scholar
  21. Cohan RH, Mahony BS, Bowie JD, Cooper C, Baker ME, Illescas FF (1987) Striated intramural gallbladder lucen- cies on US studies: predictors of acute cholecystiris. Radiology 164:31–35PubMedGoogle Scholar
  22. Cooperberg PL, Pon MS, Wong P, Stoller JL, Burhenne J (1979) Real rime high resolution ultrasound in the detection of biliary calculi. Radiology 131: 789–790PubMedGoogle Scholar
  23. Cronan JJ (1986) US diagnosis of choledocholithiasis: a reappraisal. Radiology 161: 133–134PubMedGoogle Scholar
  24. Crow HC, Bartrum RJ (1976) Ultrasound in diagnosis of acute cholecysriris. JAMA 235: 2389PubMedGoogle Scholar
  25. Crow HC, Bartrum RJ, Foote SR (1976) Expanded criteria for the ultrasonic diagnosis of gallstones. J Clin Ultrasound 4: 289–292PubMedGoogle Scholar
  26. Dennis MA, Pretorius D, Manco-Johnson ML, Bangert-Burroughs K (1985) CT detecrion of portal venous gas associated with suppurative cholangiris and cholecystiris. AJR 145: 1017–1018PubMedGoogle Scholar
  27. Dewbury KC, Smith CL (1983) The misdiagnosis of common bile duct stones with ultrasound. Br J Radiol 56: 625–630PubMedGoogle Scholar
  28. Di Pietro M, Patriguin HB, Teele RL (1985) The thick gall bladder wall in childhood as shown on ultrasonic examinarion. JEMU 6 (2): 99Google Scholar
  29. Dodds WJ, Groh HJ, Darweesh RMA, Lawson TL, Kishk SMA, Keru MK (1985) Sonographic measurement of gallbladder volume. AJR 145: 1009–1011PubMedGoogle Scholar
  30. Dolmatch BL, Laing FC, Federle MP, Jeffrey RB, Cello J (1987) AIDS-related cholangiris: radiographic findings in nine patients. Radiology 163: 313–316PubMedGoogle Scholar
  31. Doust BD, Maklad NF (1974) Ultrasonic B-mode examinarion of the gallbladder. Techniques and criteria for the diagnosis of gallstones. Radiology 110: 643–647PubMedGoogle Scholar
  32. Einstein DM, Lapin SA, Ralls PW, Halls JM (1984) The sensitivity of sonography in the detecrion of choledocholithiasis. AJR 142:725–728PubMedGoogle Scholar
  33. Eisenscher A, Sauget Y (1980) Aspect ultrasonore des asca- ridioses et distomatoses des voies biliares. J Radiol 61: 319–322PubMedGoogle Scholar
  34. Engel JM, Deitch EA, Sikkema W (1980) Gallbladder wall thickness: sonographic accuracy and relation to disease. AJR 134: 907–909PubMedGoogle Scholar
  35. Ferin P, Lemer RM (1985) Contracted gallbladder: a finding in heparic dysfunction. Radiology 154: 769–770PubMedGoogle Scholar
  36. Ferrucci JT (1987) Biliary lithotripsy: what will the issues be? AJR 149:227–231PubMedGoogle Scholar
  37. Filly RA, Moss AA, Way LW (1979) In vitro investigarion of gallstone shadowing with ultrasound tomography. J Clin Ultrasound 7: 255–262PubMedGoogle Scholar
  38. Finberg HJ, Bimholz JC (1979) Ultrasound evaluarion of the gallbladder wall. Radiology 133: 693–698PubMedGoogle Scholar
  39. Floyd JL, Collins TL (1983) Discordance of sonography and cholescinrigraphy in acute biliary obstruction. AJR 140:501–502PubMedGoogle Scholar
  40. Frentzel-Beyme B von, Fahndrich R, Aman-Thiele B (1983) Kann die Sonographic Hinweise auf die chemische Zusammensetzung von Gallensteinen geben? Fortschr Roentgenstr 138: 458–463Google Scholar
  41. Fromm H (1986) Gallstone dissolurion therapy: current status and future prospects. Gastroenterology 91: 1560–1567PubMedGoogle Scholar
  42. Goldberg BB, Harris K, Broocker W (1974) Ultrasonic and radiographic cholecystography. A comparison. Radiology 111:405–409PubMedGoogle Scholar
  43. Goldberg BB, Korier MN, Ziskin MC, Waxham RD (1975) Diagnostic uses of ultrasound. Grune and Stratton, New YorkGoogle Scholar
  44. Gooding GAW (1981) Food particles in the gallbladder mimic cholelithiasis in a parient with a cholecystojeju- nostomy. J Clin Ultrasound 9: 346–347PubMedGoogle Scholar
  45. Gross BH, Harter LP, Gore RM, Callen PW, Filly RA, Shapiro HA, Goldberg HI (1983) Ultrasonic evaluarion of common bile duct stones: prospective comparison with endoscopic retrograde cholangiopancreatography. Radiology 146: 471–474PubMedGoogle Scholar
  46. Hassani N (1976) Ultrasonography of the abdomen. Springer, Berlin Heidelberg New YorkGoogle Scholar
  47. Heriin P, Jonsson PE, Karp W (1980) Postoperative acute acalculous cholecystitis — an assessment of diagnostic procedures. Gastrointest Radiol 5: 147–149Google Scholar
  48. Holm HH, Kristensen JK, Rasmussen SN, Pedersen JF, Hancke S (1980) Abdominal ultrasound, 2nd edn. Munksgaard, CopenhagenGoogle Scholar
  49. Hwang MH (1985) Ultrasonically guided percutaneous transheparic cholecysric drainage (PTCCD) for acute cholecystiris, 3 years’ experience. 5th Worid congress of ultrasound (WFUMB), July 1985, Sydney, abstract p 127Google Scholar
  50. Jeanty P, Ammiann W, Cooperberg P, Gooding AW, Kunstlinger F, LeClercq F, Van Gansbeke D (1983) Mobile intraluminal masses of the gallbladder. J Ultrasound Med 2:65–71PubMedGoogle Scholar
  51. Jenkins M, Golding RH, Cooperberg PL (1983) Sonography and computed tomography of hemorrhagic cholecystitis. AJR 140:1197–1198PubMedGoogle Scholar
  52. Jensen F, Jensen B, Hahn L (1985) The prospective diagnostic value of real-time cholecystosonography. Eur J Radiol 5: 209–210PubMedGoogle Scholar
  53. Juhel P, Lebon P, Baudesson de Chanville D (1982) L’hé- mocholécyste: Un piège de l’hypochondre droit. JEMU 3:151–152Google Scholar
  54. Kaftori JK, Pery M, Green J, Gaitini D (1987) Thickness of the gallbladder wall in patients with hypoalbuminemia: a sonographic study of patients on peritoneal dialysis. AJR 148:1117–1118PubMedGoogle Scholar
  55. Kane RA (1980) Ultrasonographic diagnosis of gangrenous cholecystitis and empyema of the gallbladder. Radiology 134: 191–194PubMedGoogle Scholar
  56. Keller MS, Markle BM, Laffey PA, Chawla HS, Jacir N, Frank JL (1985) Spontaneous resolution of cholelithiasis in infants. Radiology 157: 345–348PubMedGoogle Scholar
  57. Kitamura T, Nakagawa F, Kawai S, Morii T, Kiyoanaga G (1971) Ultrasonographic diagnosis of cholestasis. Med Ultrasound 9: 24–26Google Scholar
  58. Krook PM, Allen FH, Bush WH, Maimer G, Maclean MD (1980) Comparison of real-time cholecystosonography and oral cholecystography. Radiology 135: 145–148PubMedGoogle Scholar
  59. Laing FC, Jeffrey RB, Ning VW (1984) AJR 143: 949–952PubMedGoogle Scholar
  60. Lawson TL (1977) Gray-scale cholecystosonography. Diagnostic criteria and accuracy. Radiology 122: 247–251PubMedGoogle Scholar
  61. Leopold GR, Asher WM (1975) Fundamentals of abdominal and pelvic ultrasonography. Saunders, PhiladelphiaGoogle Scholar
  62. Leopold GR, Sokoloff J (1973) Ultrasonic scanning in the diagnosis of biliary disease. Surg Clin North Am 53: 1043–1052PubMedGoogle Scholar
  63. Leopold GR, Amberg J, Gosink BB, Mittelstaedt C (1976) Gray-scale ultrasonic cholecystography. A comparison with conventional radiographic techniques. Radiology 121:445–448PubMedGoogle Scholar
  64. Lewandowski BJ, Winsberg F (1981) Gallbladder wall thickness distortion by ascites. AJR 137: 519–521PubMedGoogle Scholar
  65. Loughran CF, Thind CR (1985) Gallbladder infarction: a radiographic mimic of emphysematous cholecystitis. Eur J Radiol 5: 109–110PubMedGoogle Scholar
  66. Love MB (1982) Sonographie features of milk of calcium bile. J Ultrasound Med 1: 325–327PubMedGoogle Scholar
  67. Lutz H, Seidl R, Petzold R, Fuchs HF (1975) Gallensteindiagnostik mit Ultraschall. Dtsch Med Wochenschr 100: 1325–1331Google Scholar
  68. Madrazo BL, Francis I, Hricak H, Sandler MA, Hudak S, Gitschlag K (1982) Sonographic findings in perforation of the gallbladder. AJR 139: 491–496PubMedGoogle Scholar
  69. Marchal GJF, Crolla D, Baert AL, Fevery J, Kerremans R (1978) Gallbladder wall thickening: A new sign of gallbladder disease visualized by gray-sale cholecystosonography. J Clin Ultrasound 6: 177–178Google Scholar
  70. Marchal GJF, Casaer M, Baert AL, Goddeeris PJ, Kerremans R, Fevery J (1979) Gallbladder wall sonolucency in acute cholecystitis. Radiology 133: 429–433PubMedGoogle Scholar
  71. Marchal GJF, Fevery J, Snowball S, van Hoolsbeeck M, Oyen R, Adisoejoso B, Kerremans R, Gruwez J, Geboes K, Baert A (1985) The sonographic aspects of haemobilia. Eur J Radiol 5: 211–215PubMedGoogle Scholar
  72. Menu Y, Scherrer A, Nahum H (1982) Cholécystite aiguë alithiasique en traumatologie. J Radiol 63: 613–616PubMedGoogle Scholar
  73. Menu Y, Lorphelin JM, Scherrer A, Grenier P, Nahum H (1985) Sonographic and computed tomographic evaluation of intrahepatic calculi. AJR 145: 579–583PubMedGoogle Scholar
  74. Mueller PR, Cronan JJ, Simeone JF, Van Sonnenberg E, Hall DA (1983) Choledocholithiasis: Ultrasonographic caveats. J Ultrasound Med 2: 13–16Google Scholar
  75. Nemcek AA, Gore RM, Vogelzang RL, Grant M (1988) The effervescent gall bladder: a sonographic sign of emphysematous cholecystitis. AJR 150: 575–577PubMedGoogle Scholar
  76. Neoptolemos JP, Hofmann AF, Moossa AR (1986) Chemical treatment of stones in the biliary tree. Br J Surg 73: 513–524Google Scholar
  77. Parulekar SG (1982) Sonographic findings in acute emphysematous cholecystitis. Radiology 145: 117–119PubMedGoogle Scholar
  78. Patriquin HB, Di Pietro M, Barber FE, Littlewood Teele R (1983) Sonography of thickened gallbladder wall: causes in children. AJR 141:57–60PubMedGoogle Scholar
  79. Purdom RC, Thomas ST, Kereiakes JG, Spitz HB, Goldenberg NJ, Krugh KB (1980) Ultrasonic properties of biliary calculi. Radiology 136: 729–732PubMedGoogle Scholar
  80. Quinn SF, Fazzio F, Jones E (1987) Torsion of the gallbladder: findings on CT and sonography and role of percutaneous cholecystostomy. AJR 148: 881–882PubMedGoogle Scholar
  81. Ralls PW, Colletti PM, Lapin SA, Chandrasoma P, Boswell WD, Ngo C, Radin DR, Halls JM (1985) Real-time sonography in suspected acute cholecystitis. Radiology 155:767–771PubMedGoogle Scholar
  82. Raptopoulos V, Compton CC, Doherty P, Smith EH, D’Orsi CJ, Patwardhan NA, Goldberg R (1986) Chronic acalculous gallbladder disease: multiimaging evaluation with clinical-pathologic correlation. AJR 147: 721–724PubMedGoogle Scholar
  83. Raskin MM (1978) Hepatobiliary disease: a comparative evaluation by ultrasound and computed tomography. Gastrointest Radiol 3: 267PubMedGoogle Scholar
  84. Rettenmaier G (1976) Sonographischer Oberbauchstatus. Aussagefähigkeit und Indikationen der Ultraschall- Schnittbilduntersuchung des Oberbauches. Internist (Beriin) 17: 549–564Google Scholar
  85. Riegg H, Getter B (1975) Sonography or x-ray examination of the gallbladder. Ultrasonics in medicine (abstract no 96). Second European Congress, Munich. 1975Google Scholar
  86. Rucin B, Ulrich JL, Durupt B, Valeri J, Bloch J (1979) Valeur diagnostique comparée de la cholécystographie et de l’échographie dans la lithiase vésiculaire. Communication au Congrès National de la SFAUMB, Marseille, October 1979Google Scholar
  87. Ruiz R, Teyssou H, Tessier JP (1980) Apport de l’échotomographie dans le diagnostic des hémobilies. A propos d’un cas après ponction biopsie hépatique transpariétale. Ann Radiol 23 (1): 52–55PubMedGoogle Scholar
  88. Sansot M, Vadrot D, Ritano D, Jouve P (1983) Image échographique de cloisonnement vésiculaire. 8 observations. J Radiol 64: 687–692PubMedGoogle Scholar
  89. Sauerbruch T, Delius M, Pan G et al. (1986) Fragmentation of gallstones by extracorporeal shockwaves. N Engl J Med 314: 818–822PubMedGoogle Scholar
  90. Schulman A, Loxton AJ, Heydenrych JJ, Abdurahaman KE (1982) Sonographic diagnosis of biliary ascariasis. AJR 139: 485–489PubMedGoogle Scholar
  91. Simeone JF, Mueller PR, Ferrucci JT, Harbin WP, Wittenberg J (1980) Significance of nonshadowing focal opacities at cholecystosonography. Radiology 137: 181–185PubMedGoogle Scholar
  92. Simeone JF, Mueller P, Butch RJ, Van Sonnenberg F, Ferrucci JT, Hall DA, Kopans DB, Dawson SL, Winttenberg J, McCarthy K (1985) The bileducts after a fatty meal: further sonographic observations. Radiology 154: 763–768PubMedGoogle Scholar
  93. Sommer FG, Taylor KJW (1980) Differentiation of acoustic shadowing due to calculi and gas collections. Radiology 135: 399–403PubMedGoogle Scholar
  94. Stoller JL, Cooperberg PL, Simpson WM (1979) Diagnostic ultrasonography in acute cholecystitis. Can J Surg 22: 374–376PubMedGoogle Scholar
  95. Strijk SP, Boetes C, Rosenbusch G (1981) Floadng stones in a nonopacified gallbladder: ultrasonographic sign of gas-containing gallstones. Gastrointest Radiol 6: 261–263Google Scholar
  96. Swayne LC (1986) Acute acalculous cholecystitis: sensitivity in detection using Technetium-99m iminodiacetic acid cholescintigraphy. Radiology 160: 33–38PubMedGoogle Scholar
  97. Taylor JW (1979) Diagnostic ultrasound in gastrointesrinal disease. Churchill Livingstone, EdinburghGoogle Scholar
  98. Teixidor HS, Honig CL, Norsoph E, Albert S, Mouradican JA, Whalen JP (1987) Cytomegalovirus infecrion of the alimentary canal: radiologic fmdings with pathologic correlarion. Radiology 163: 317–323PubMedGoogle Scholar
  99. Triller J, Knutti D (1978) Sonographische Diagnosrik der Cholezystopathie. Schweiz Med Wochenschr 108: 380–386PubMedGoogle Scholar
  100. Tsujimoto F, Miyamoto Y, Tada S (1985) Differenriarion of benign from malignant ascites by sonographic evaluation of gallbladder wall. Radiology 157: 503–504PubMedGoogle Scholar
  101. Van Sonnenberg E, Casóla G, Cubberley DA, Halasz NA, Cabrera OA, Wittich GR, Mattrey RF, Scheibie F (1986) Oriental cholangiohepatitis: diagnostic imaging and in- tervenrinal management. AJR 146: 327–331Google Scholar
  102. Von Gladisch R, Deininger HK (1983) Die Darstellung von Gallensteinen im Sonogramm und Radiogramm. Fortschr Röntgenstr 139: 249–255Google Scholar
  103. Weill F (1980) L’ultrasonographie en pathologie digestive. Vigot, ParisGoogle Scholar
  104. Weill F, Gisselbrecht H, Ricatte JP, Kraehenbuhl JR, Schraub S, Becker JC (1971) Diagnosric tomo-échogra- phique des dilatarions vésiculaires. Arch Fr Mal App Dig 60: 49–54PubMedGoogle Scholar
  105. Weill F, Becker JC, Kraehenbuhl JR, Heriot G, Walter JP (1973) Atlas clinique de radiographie ultrasonore. Masson, ParisGoogle Scholar
  106. Weill F, Marmier A, Paronneau P, Zeltner F, Rohmer P (1979) Etude ultrasonore des ictères. Séméiologie. Résultats à propos de 199 cas. J Radiol 59: 659–668Google Scholar
  107. Weill F, Le Mouel A, Bihr E, Rohmer P, Zeltner F, Sauget Y (1980) Le diagnosric ultrasonore des collections intra- péritonéales dans le récessus hépatorénal (ou le récusses spléno-péritonéal): le signe du croissant de lune. J Radiol 61: 251–256PubMedGoogle Scholar
  108. White M, Simeone JF, Muller PR (1983) Imaging of chole-cystocoHc fistulas. J Ultrasound Med 2: 181–185PubMedGoogle Scholar
  109. Zeman RK, Lee C, Stahl RS et al. (1982) Ultrasonography and hepatobiliary scinrigraphy in the assessment of biliary-enteric anastomoses. Radiology 145: 109–115PubMedGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 1990

Authors and Affiliations

  • Francis S. Weill
    • 1
  1. 1.Chaire de RadiodiagnosticRadiologie A Hôpital Jean MinjozBesançonFrance

Personalised recommendations