Saturday, September 18, 2010

Gall bladder calculi- Ultrasound video clips:

This patient has multiple small calculi (each of 3 to 4 mm.) in the gall bladder. She tried various conservative remedies, despite which there has been no success.
For more on this topic visit:  

Case-2: showing motion of calculi within distended Gall bladder:
Ultrasound image shows one calculus in the gall bladder, in the dependent part, close to the neck. Not sure about the number of gall bladder stones....So what do we do?

Ultrasound video clip shows what looked like a single stone in the gall bladder are in fact two separate and relatively large calculi. Observe the motion of the two gall bladder stones floating from the neck to fundus as patient turns from supine to left lateral posture.

And later, as the patient turns to the supine position from the left lateral posture, the stones are seen moving from the fundus to GB neck.

Conclusion: postural change can help visualize hidden gall bladder calculi.

Case-3: large gallbladder calculus:
Ultrasound image shows a large calculus (1.5 cms.) near the neck of gallbladder. Two questions arise here: is this a solitary calculus and is this a sludge ball or a calculus?  

Ultrasound video clip above shows this is a single large calculus (seen moving from fundus of gallbladder to the neck, as patient rotates). Also not the strong acoustic shadow of the calculus, ruling out a biliary sludge ball.
And this video shows this whopper of a GB calculus dancing all the way from the neck of gall bladder to the fundus:

Another case of fine gall bladder calculi and biliary sludge in a 5 year old child:
 It is pretty difficult to say clearly if those fine echoes in the gall bladder are sludge or calculi. Perhaps it is a mixture of both.

I posted another ultrasound video clip of this case via you tube. The difference in the imaging quality is striking.

The ultrasound image above shows distended gall bladder with abundant echoes within it (same case).

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