Anthony Edward Hanbidge MBBCh, Presenter: Nothing to Disclose

1) Discuss the value of ultrasound when assessing the gallbladder and bile ducts. 2) Identify the imaging features of acute conditions of these structures and complications. 3) Recognize common pitfalls to avoid misinterpretation. 4) Briefly describe other conditions of the gallbladder and bile ducts including sclerosing cholangitis, cholangiocarcinoma, IgG4 associated cholangitis, adenomyomatosis, gallbladder polyps and gallbladder cancer.

Acute cholecystitis is the most common cause of acute pain in the right upper quadrant (RUQ), and urgent surgical removal of the gallbladder is the treatment of choice for uncomplicated disease. However, cross-sectional imaging is essential because more than one-third of patients with acute RUQ pain do not have acute cholecystitis. In addition, patients with complications of acute cholecystitis, such as perforation, are often best treated with supportive measures initially and elective cholecystectomy at a later date. Ultrasound (US) is the primary imaging modality for assessment of the gallbladder and bile ducts; US is both sensitive and specific in demonstrating gallstones, biliary dilatation, and features that suggest acute inflammatory disease. It is sensitive at detecting abnormalities of the wall of the gallbladder and bile ducts. Often, additional imaging modalities are indicated. Computed tomography (CT) is valuable, especially for confirming the extent and nature of the complications of acute cholecystitis. Magnetic resonance (MR) cholangiopancreatography is helpful in complicated ductal disease (eg, recurrent pyogenic cholangiohepatitis) when more detailed diagnostic information is required for treatment planning, whereas endoscopic retrograde cholangiopancreatography is used when biliary intervention is required (eg, treatment of choledocholithiasis). Both CT and MR are accurate when staging malignancies of the gallbladder and bile ducts. Successful imaging with all modalities requires familiarity with both the characteristic and the unusual features of a wide variety of pathologic conditions. In addition, potential pitfalls must be recognized and avoided.

Hanbidge, A, Gallbladder and Biliary Disease.  Radiological Society of North America 2014 Scientific Assembly and Annual Meeting, - ,Chicago IL. http://archive.rsna.org/2014/14000566.html