This document contains descriptions and images of various gallbladder and biliary conditions. It includes 24 figures showing different gallstones, bile duct abnormalities, and imaging findings related to diseases of the gallbladder and biliary tree. The figures demonstrate conditions such as cholecystitis, cholangitis, strictures, cysts, tumors, and other pathologies seen in gallbladder and bile duct imaging.

1. 24
DAVID SUTTON

2. DAVID SUTTON PICTURES
DR. Muhammad Bin Zulfiqar
PGR-FCPS III SIMS/SHL

4. • Fig. 24.2 Small, very dense stones, probably
calcium carbonate.

5. • Fig. 24.3 ' Mixed stones' showing lamination
and facets.

7. • Fig. 24.5 ' Mulberry stones' in gallbladder and
bile duct (arrow).

8. • Fig. 24.6 ' Li my bile' (calcium carbonate sand)
on erect film.

9. • Fig. 24.7 Calcified ('porcelain') gallbladder;
the common duct is dilated and contains a
large stone (arrow).

10. • Fig. 24.8 Emphysematous cholecystitis
showing (A) gas in the lumen and wall of the
gallbladder and (B) a gas-fluid level in the
erect posture.

11. • Fig. 24.9 Gas in biliary tree
following endoscopic
sphincterotomy (-s). Note
overlying benign calcifying
breast disease (<-).

12. • Fig. 24.10 Chronic Ascaris abscess of liver. The
worms are seen in contrast against gas in the
cavity.

13. • Fig. 24.11 Large stone (arrow) impacted in
the neck of the gallbladder. Note the dense
acoustic shadow.

14. • Fig. 24.12 Multiple small stones (arrows) in
the dependent part of the gallbladder. No
acoustic shadow.

15. Fig. 24.13 Acalculous cholecystitis. The
gallbladder wall is thickened and reduced in
echogenicity.

16. • Fig. 24.14 (A) Chronic cholecystitis (see text).
(B) Inflammatory thickening of the wall of the
bile duct seen in transverse section at the
level of the bifurcation (arrows).

17. • Fig. 24.15 Gallbladder polyp fixed to the
ventral wall of the gallbladder.

18. • Fig. 24.16 (A) Calculus obstruction. Note acoustic shadow and the thin
rim of bile around the front edge of the stone (arrow). (B) Coronal MIP
image of an MR cholangiopancreatogram (MRCP) (TSE 2320/380) showing
proximal stenoses (arrow) of the common bile (b) and pancreatic (p) ducts
from a cholangiocarcinoma. There is a plastic F5 catheter in situ within the
common bile duct which i s not producing any signal artefact. g =
gallbladder; L = left. (Courtesy of Dr J. P. R. J enkins.) (C) MR
cholangiography showing biliary dilatation due to anastomotic bile duct
stricture following liver transplant.

19. • Fig. 24.16 (A) Calculus obstruction. Note acoustic shadow and the thin
rim of bile around the front edge of the stone (arrow). (B) Coronal MIP
image of an MR cholangiopancreatogram (MRCP) (TSE 2320/380) showing
proximal stenoses (arrow) of the common bile (b) and pancreatic (p) ducts
from a cholangiocarcinoma. There is a plastic F5 catheter in situ within the
common bile duct which i s not producing any signal artefact. g =
gallbladder; L = left. (Courtesy of Dr J. P. R. J enkins.) (C) MR
cholangiography showing biliary dilatation due to anastomotic bile duct
stricture following liver transplant.

21. • Fig. 24.18 (A-D) 99 n,Tc-dimethyl-IDA. Serial images at
7 min, 15 min, 80 min and 270 min, showing transit of
radioactivity through the liver into the small gut and
ascending colon. The gallbladder is not shown,
indicating cystic duct obstruction. (Courtesy of
Professor E. Rhys Davies.)

22. • Fig. 24.19 Small cholesterol calculi which
float in the erect posture. within a proximal
segment of bowel with delayed transit
through (A) Prone. (B) Erect.

23. • Fig. 24.20 Percutaneous cholangiography
demonstrating an intrahepatic
cholangiopathy of biliary atresia following
portoenterostomy. There is some preservation
of normal duct morphology but intrahepatic
strictures and calculi are features.

24. • Fig. 24.21 Severe biliary atresia with obliteration
of intrahepatic bile ducts. Hyperplastic
lymphatics allow some drainage of bile into the
constructed portoenterostomy (Kasai procedure).
This is the most common type and carries the
worst prognosis.

25. • Fig. 24.22 Fusiform choledochal cyst with a
long common channel and associated
stricture at the pancreaticobiliary junction.

26. • Fig. 24.23 CT of a large choledochal cyst with
biliary obstruction.

27. • Fig. 24.24 Caroli's disease
with characteristic
strictures and segmental
• intrahepatic dilated ducts.

28. • Fig. 24.25 Biliary obstruction secondary to an
acquired 'atresia' in a neonate following a
perforated bile duct.

29. • Fig. 24.26 Characteristic intrahepatic
strictures of sclerosing cholangitis.

30. • Fig. 24.27 Empyema of the gallbladder. The
true nature of the fine internal echoes can
only be determined by aspiration.

31. • Fig. 24.28 Cholesterosis, showing fixed mural
defects.

32. • Fig. 24.29 Types of adenomyomatosis. (A) A
fundal nodule before and after contraction.
(B) Stricture before and after contraction. (C)
Rokitansky-Aschoff sinuses.

33. • Fig. 24.30 (A,B) Fundal nodule of
adenomyomatosis before and after
gallbladder contraction. Note long cystic duct
medial to common bile duct, a congenital
anomaly.

34. • Fig. 24.31 Cholecystogram of phrygian cap
resulting from partial septum across the fundus
of an otherwise normal gallbladder. This is a
normal variant.

35. • Fig. 24.32 Rokitansky-Aschoff sinuses shown
on the after fatty meal film at
cholecystography. Stricture is also present.

36. • Fig. 24.33 Acute suppurative cholangitis. (A) Abscess cavities
communicating with dilated ducts following stricture of
choledochoenterostomy for malignant disease. (B) After 5 days external
drainage via transhepatic tubes, most of the abscess cavities have healed
and the ducts are less distended. Biliary sepsis rarely occurs in association
with malignant obstruction unless there has been previous intervention.

37. • Fig. 24.33 Acute suppurative cholangitis. (A) Abscess cavities
communicating with dilated ducts following stricture of
choledochoenterostomy for malignant disease. (B) After 5 days
external drainage via transhepatic tubes, most of the abscess cavities
have healed and the ducts are less distended. Biliary sepsis rarely
occurs in association with malignant obstruction unless there has been
previous intervention.

38. • Fig. 24.34 Very large gallstone (arrow) in dilated bile
duct shown at ERC.

39. • Fig. 24.35 ' Meniscus' sign of impacted stone
(arrow) in bile duct.

40. • Fig. 24.36 Multiple calculi forming within the
common duct following a distal bile duct trauma.

41. • Fig. 24.37 Correction of a bile leak with surgical drainage via a
Roux loop of a sectorial right duct transected at cholecystectomy.
The stent demarcates the line of the common bile duct, into which
the transected duct had an anomalous insertion which was not
recognised at laparoscopic cholecystectomy.

42. • Fig. 24.38 Benign
postcholecystectomy
stricture of common duct
(arrow). Typical site at level
of ligation of cystic duct.

43. • Fig. 24.39 Stricture of a hepaticojejunostomy.

44. • Fig. 24.40 Bile duct stricture developing
following hepatic resection (A). Recurrent
stricturing following biliary reconstruction
which was successfully treated by balloon
dilatation (B).

45. • Fig. 24.41 Subcapsular bile leak following
blunt liver trauma.

46. • Fig. 24.42 Percutaneous cholangiography
demonstrating a leak from the bile duct
following blunt abdominal trauma.

47. • Fig. 24.43 Characteristic stricturing of
sclerosing cholangitis involving the intra- and
extrahepatic biliary system.

48. • Fig. 24.44 Low common bile duct stricture, with
characteristic features of extrinsic compression
from a pancreatic mass (arrow).

49. • Fig. 24.45 ' Rat-tail' stricture of common bile
duct due to chronic pancreatitis. Note
calcification in pancreatic head.

50. • Fig. 24.46 Ascaris lumbricoides. (A) Ascaris worm in
the biliary ducts. (B) Cholecystostomy tube study
showing multiple worms extending from common
• bile duct into duodenum. Note associated abscess in
right lobe of liver.

51. • Fig. 24.47 Extrinsic
compression along the
line of the common duct
from choledochal varices
secondary to portal vein
thrombosis.

52. • Fig. 24.48 Cholangiocarcinoma of the hilum with
a characteristic stricture involving the confluence
of the main left and right hepatic ducts

53. • Fig. 24.49 Papilliferous
tumour infiltrating and
expanding the common
bile duct.

54. • Fig. 24.50 Direct cholangiography defining the intraductal
extension of a biliary cystadenoma of the left liver

55. Fig. 24.51 ' Double duct' sign.
Concomitant strictures of
pancreatic duct and bile
duct (arrows) diagnostic of
carcinoma of head of
pancreas.

56. • Fig. 24.52 Percutaneous cholangiography
demonstrating obstruction of the Roux loop
following hepaticojejunostomy.

57. • Fig. 24.53 (A) A fine-needle duct system is used to
opacify the ducts and introduce a catheter. (B) An
appropriate guide-wire is manipulated through the
stricture. (C) A sheath introduction system is then
placed into the ducts to allow delivery of the plastic or
metallic stent. (D) The sheath is removed and external
drainage may be used for the first 24 h if necessary.
This will allow subsequent cholangiography to confirm
optimum stent deployment and internal drainage.

58. • Fig. 24.53 (A) A fine-needle duct system is used to
opacify the ducts and introduce a catheter. (B) An
appropriate guide-wire is manipulated through the
stricture. (C) A sheath introduction system is then
placed into the ducts to allow delivery of the plastic or
metallic stent. (D) The sheath is removed and external
drainage may be used for the first 24 h if necessary.
This will allow subsequent cholangiography to confirm
optimum stent deployment and internal drainage.

59. • Fig. 24.54 Transhepatic endoprosthesis. (A) A guide-wire has been
manipulated through the completely obstructing lesion of the
common hepatic duct. (B) An endoprosthesis (arrow) has been
positioned through the stricture. (C) Two days later,
cholangiography through the external drain (arrow) shows that the
prosthesis is functioning (contrast in duodenum) and that the
intrahepatic ducts have been decompressed. The external drain is
now removed.