Department of Radiology, Pusan Paik Hospital, College of Medicine, Inje University Department of Radiology, Medical College, Donga University1
ABSTRACT
PURPOSE : This study was done to find answers for further following questions in cases of the collapsedgallbladder (GB) : What is the probability of the presence of stone when stony echo is visible in GB area? What isthe probability of the presence of stone when only acoustic shadow is visible from GB area? What are theassociated GB pathologies except stone or cholecystitis in previously mentioned situations and is it possible todifferentiate them? What are the underlying pathologies of GB collapse without stony echo or acoustic shadow andis it possible to differentiate them sonographically? What are the rate and causes of re-expansion of thecollapsed GB on follow-up study? MATERIAL & METHODS : Prospective study was done in 157 cases of collapsed GB withno visible or nearly no visible bile filled lumen in reent 3 years. Sonographic analysis for GB lesions was donein 61 confirmed cases. Changing pattern of GB lumen on follow-up study and their underlying pathologies wereanalized in 28 cases. Initial sonographic examination was done with 3 or 3.5 MHz transducer. No other transducerwas used in cases showing stony echo or acoustic shadow in GB area, but additional examination was done with 5 or7-4 MHz transducer in cases without stony echo or acoustic shadow. RESULTS : Among 31 cases, which showed stonyecho, stone was found in 30 cases and milk of calcium bile in one case. Stone was present in all of the 11 caseswhich showed only acoustic shadow from the collapsed GB without stony echo. GB cancer was accompanied in 2 casesamong upper 42 cases, and its possibility could be suspected sonographically. Underlying pathologies of the 19cases without stony echo or acoustic shadow were as follows : GB stone (3), cholecystitis (6), GB cancer (1), bileplug syndrome (1), hepatitis (5), and ascites (3). And sonographic differentiation of the underlying causes forthe collapse was possible in only 1 case of GB cancer. Among 28 cases of the follow-up study, 20 cases showedre-expansion of the GB lumen and their underlying pathologies were as follows : gall stone(10), hepatitis(5),ascites(3), and cholecystitis(2). CONCLUSION : According to our results, we can conclude that US is very accurateto diagnose gall stone in cases showing stony echo or acoustic shadow even in the collapsed gallbladder but it isnearly impossible to differentiate underlying pathologies in cases without such findings and the possibility ofre-expansion of GB must be considered before the final decision of surgical treatment for any collapsedgallbladder.
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