basic techniques for gallbladder sonography , basic anatomic review

1. GALLBLADDER ULTRASOUND
PROTOCOL
Dr.Tayseer jamal Aldeen , Radiologist.
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2. Gallbladder and Biliary Tract
 ESSENTIAL ANATOMY AND PHYSIOLOGY OF THE
GALLBLADDER AND BILIARY TRACT
Gallbladder
 The cystic duct connects the gallbladder to the biliary
tract.
 The gallbladder has a partially inflated balloon shape
that consists of a neck, body,
 and fundus.
 The neck is the narrowest segment of the gallbladder
and is thus the most common
 location for gallstones to become trapped.
 The body is the widest segment of the gallbladder.
 The fundus is the most dependent part of the
gallbladder and is thus the most likely
 part to contain gallstones.
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Al-Noor University College
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3. PATIENT PREPARATION FOR SONOGRAPHY OF THE
GALLBLADDER AND BILIARY TRACT
PATIENT PREPARATION FOR SONOGRAPHY OF THE
GALLBLADDER AND BILIARY TRACT
 NPO for 6–8 hrs is optimal,
Equipment
 3–5-MHz transducer
 General abdominal setting (most machines)
 In Supine and left lateral decubitus position
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Al-Noor University College
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4. SUGGESTED PROTOCOL
 With the patient in the supine position, obtain a brief survey of the
gallbladder in (either or both) the longitudinal and transverse scan
planes.
 Longitudinal gallbladder:
1. Images should be oriented to the long axis of the gallbladder and
thus the transducer may need to be placed in an oblique
orientation to obtain the entire length of the gallbladder. The neck,
body, and fundus should be demonstrated
2. Assess for intraluminal objects, like gallstones, polyps, or masses.
3. Assess for wall thickening and pericholecystic fluid.
Transverse gallbladder:
1. Images should be oriented 90° to the long axis of the gallbladder
and thus the
transducer may need to be placed in an oblique orientation to obtain
these images.
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Al-Noor University College
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5. Tranverse scan --------- Longitudinal scan
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6. Left lateral decubitus images:
1) Repeat longitudinal and transverse images of the gallbladder in the left
lateral decubitus position.
2) Assess for intraluminal objects, like gallstones, polyps, or masses.
3) Assess for wall thickening and pericholecystic fluid.
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Al-Noor University College
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7.  Long common duct:
 The image should be oriented to
the long axis of the porta hepatis
to demonstrate the
 length of the common hepatic
duct and common bile duct (Fig.
4-10).
 Measurements of the ducts are
obtained from the inner wall to
the inner wall.
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Al-Noor University College
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8.  SCANNING TIPS
 Gallbladder:
1) Deep suspended inspiration will assist in displacing the gallbladder
inferiorly.
2) Evaluate the gallbladder through the right-side rib windows when
necessary.
3) A smaller transducer face may be helpful.
If the gallbladder is not visualized ???
1. Inquire about previous cholecystectomy
2. Inquire about fasting status
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Al-Noor University College
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9. NORMAL MEASUREMENTS OF THE GALLBLADDER AND
BILIARY TRACT
 Gallbladder :
 Size = 8–10 cm in length and 4–5 cm in diameter
 Normal gallbladder wall thickness = <3 mm
 Biliary tract:
 Intrahepatic ducts diameter = <2 mm
 Common bile duct diameter = <7–8 mm (depending on patient’s age and
other factors) *
 Bile duct wall thickness = <5 mm
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Al-Noor University College
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10.  Gallbladder Fold
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11.  Cholilithiasis = Gallstones
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12.  Gall bladder polyp
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13.  Acute cholycystitis
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14. 1/15/2023
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15. Thank you
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Al-Noor University College
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