Also, previous ultrasound imaging also showed the same findings.
The patient was in a fasting state on the day of scan.
Besides, the gallbladder is well distended.
What are the diagnostic possibilities in this case?
As the gallbladder wall is uniformly thickened, and there is no tenderness or pain present, the most likely diagnosis is chronic cholecystitis, which is inflammation of the gallbladder. This condition can occur without the presence of gallstones and is more common in individuals over the age of 40.
Other possible causes of a uniformly thickened gallbladder wall without tenderness or pain include:
1. Gallbladder adenomyomatosis: This is a condition where the inner wall of the gallbladder becomes thickened and forms pockets. It is usually benign, but in some cases, it can cause symptoms such as abdominal pain or discomfort.
2. Prolonged fasting: Long periods of fasting or starvation can cause gallbladder wall thickening.
3. Gallbladder polyps: These are growths on the gallbladder wall that can cause thickening.
4. Systemic diseases: Certain systemic diseases such as diabetes, lupus, or scleroderma can cause thickening of the gallbladder wall.
Some other possible differential diagnoses for gallbladder wall thickening include:
- Cholecystitis (acute, chronic, acalculous, xanthogranulomatous)
- Gallbladder empyema; excluded as there were no symptoms.
- Postprandial physiological state (pseudothickening); here, patient was fasting since morning.
- Secondary thickening (hepatic cirrhosis, hepatitis, congestive right heart failure, Fitz-Hugh-Curtis syndrome, hypoalbuminemia, ascites). None of these were present.
- Other acute inflammatory processes in the right upper quadrant (acute pancreatitis, perforated duodenal ulcer, acute pyelonephritis, peritonitis). Not likely in this patient.
- Primary sclerosing cholangitis
- Gallbladder perforation. Not likely.
- Brucellosis
- AIDS cholangiopathy
- Severe pyelonephritis
- Renal failure
- Gallbladder carcinoma
- Diffuse adenomyomatosis of the gallbladder
- Hemophagocytic lymphohistiocytosis (HLH).
If there are no symptoms present, treatment may not be necessary, but further evaluation may be needed to rule out any underlying conditions. Follow-up ultrasound or other imaging tests may be recommended to monitor any changes in the gallbladder wall thickness.
Final diagnosis: Possibly idiopathic thickening of gallbladder wall.
D/d: chronic acalculous cholecystitis
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What is idiopathic gallbladder wall thickening?
Idiopathic thickening of the gallbladder wall refers to a condition where the wall of the gallbladder becomes thicker than normal, but the underlying cause is unknown or idiopathic.
The gallbladder is a small pear-shaped organ located in the upper right quadrant of the abdomen, beneath the liver. Its main function is to store and release bile, a fluid that aids in the digestion of fats. The normal thickness of the gallbladder wall is less than 3mm.
Idiopathic thickening of the gallbladder wall is often diagnosed incidentally during an ultrasound or CT scan that was ordered for another reason. In many cases, patients may not exhibit any symptoms, and the condition is discovered accidentally during routine check-ups.
The thickening of the gallbladder wall may be due to inflammation, infection, or other underlying medical conditions such as gallstones, cholecystitis, hepatitis, or cirrhosis. However, in some cases, there may be no clear underlying cause for the thickening of the gallbladder wall, and it is classified as idiopathic.
In patients with idiopathic thickening of the gallbladder wall, doctors may monitor the condition through regular follow-up visits and imaging studies. Treatment may not be necessary unless the patient experiences symptoms or the gallbladder wall becomes excessively thick.
Symptoms of idiopathic thickening of the gallbladder wall may include pain in the upper right abdomen, nausea, vomiting, and fever. In some cases, patients may also develop jaundice.
Management: follow up ultrasound and further investigations if needed.
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