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Biliary lithiasis 最佳影像診斷線索 : Echogenic foci with posterior acoustic shadowing (10% stones: No acoustic shadow) in US Discrete & (movable) lower signal (density) filling defects within bile ducts in MRC and ERCP Opaque stones (20%) in plain radiography
Treatment: stone < 3 mm : usu. spontaneously pass stone 3-10 mm : endoscopic sphicterotomy * stone retrieval balloon to sweep duct * basket to snare stones stone > 10-15mm : require fragmentation by mechanical lithotripsy
Milk of calcium bile Calcium carbonate precipitate within gall bladder lumen (calcium milk) 最佳影像診斷線索 : Identification of calcified liquid within gallbladder (echogenic fluid similar to sludges but with acoustic shadowing) Incidental finding: asymptom or RUQ pain Etiology: GB stasis ~ Ca++ carbonate in bile, thickness of GB wall
Porcelain GB Calcification of gallbladder wall 最佳影像診斷線索 : Rim of calcification in RUQ conforming to GB shape Usually asymptomatic ; old age Rish factor for gallbladder carcinoma Prophylactic cholecystectomy is current consensus recommendation
Chronic Cholecystitis Two appearance Small, contracted, sclerosed GB with/without stones (fasting state) Same imaging appearance as acute cholecystitis but without Murphy sign (terderness)
Small, contracted, sclerosed GB; even non-visualization of GB (during fasting state)
Mirizzi syndrome Partial or complete obstruction of common hepatic duct (CHD) due to gallstone impacted in cystic duct or gall bladder neck 最佳影像診斷線索 : Impacted cystic duct stone on US with proximal dilatation of intraheptic ducts
現 在 史 previous history of liver cirrhosis with ascites, started nausea, vomiting, fever and abdominal pain for three days before admission. He was brought to nearby hospital for hospitalization. However, signs and symptoms persist, and he was diagnosed to have peritonitis of unknown cause. He is then transferred to our hospital for further evaluation and management. At the ER, abdomen CT ~~~
Pathological No.: 962230 Date of Arrival: 2007/8/7 Date of Report: 2007/8/8 Pathological diagnosis: Gall bladder, cholecystectomy ----- ----- Chronic cholecystitis with acute exacerbation and cholelithiasis Gross: The specimen consists of an opened gall bladder, measuring 9.2 x 4.5 x 3 cm in size. It is enlarged. The wall is thickened and measuring up to 0.5 cm in thickness. The mucosal folds are absent. There are several pieces of black stone in the lumen. Representative parts are embedded in one block. Microscopy: The sections show a picture of edema, neutrophilic infiltration, congestion, hemorrhage, abscess formation, fibrosis and focal chronic inflammatory cell infiltration in the lamina propria, muscular layer and perimuscular layer. Rokitansky-Aschoff sinuses are present.