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Cannata D, Chin KA, Anslip A, She T, Lotterman S, Herbst T, Herbst MK. Association of biliary distention with a diagnosis of acute cholecystitis. Am J Emerg Med 2024; 81:130-135. [PMID: 38728935 DOI: 10.1016/j.ajem.2024.04.056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2024] [Revised: 04/29/2024] [Accepted: 04/30/2024] [Indexed: 05/12/2024] Open
Abstract
BACKGROUND Gallbladder distention has been described in radiology literature but its value on point-of-care ultrasound (PoCUS) performed by emergency physicians is unclear. We sought to determine the test characteristics of gallbladder distention on PoCUS for cholecystitis (acute or chronic), and secondarily whether distention was associated with an obstructing stone-in-neck (SIN), acute cholecystitis on subsequent pathology report, and longer cholecystectomy operative times. METHODS This was a dual-site retrospective cohort study of all Emergency Department (ED) patients that underwent diagnostic biliary PoCUS and were subsequently admitted from 11/1/2020 to 10/31/2022. Patients with pregnancy, liver failure, ascites, hepatobiliary cancer, prior cholecystectomy, or known cholecystitis were excluded. Gallbladder distention was defined as a width ≥4 cm or a length ≥10 cm. Saved ultrasound images were reviewed by three independent reviewers who obtained measurements during the review. Test characteristics, Cohen's kappa (κ), and strength of association between distention and our variables (acute cholecystitis on pathology report and SIN on PoCUS) were calculated using a Chi Square analysis, where intervention (cholecystectomy, percutaneous cholecystostomy, or intravenous antibiotics) was used as the reference standard for AC. A one-tail two sample t-test was calculated for mean operative times. RESULTS Of 280 admitted patients who underwent ED biliary PoCUS, 53 were excluded, and 227 were analyzed. Of the 227 patients, 113 (49.8%) had cholecystitis according to our reference standard, and 68 (30.0%) had distention on PoCUS: 32 distended by both width and length, 16 distended by width alone, and 20 distended by length alone. Agreement between investigators was substantial for width (κ 0.630) and length (κ 0.676). Distention was 85.09% (95% CI 77.20-91.07%) specific and 45.1% (95% CI 35.8-54.8%) sensitive for cholecystitis. There was an association between distention and SIN; odds ratio (OR) 2.76 (95% CI 1.54-4.97). Distention of both length and width was associated with acute over chronic cholecystitis; OR 4.32 (95% CI 1.42-13.14). Among patients with acute cholecystitis, mean operative times were 114 min in patients with distention and 89 min in patients without distention (p = 0.03). CONCLUSION Gallbladder distention on PoCUS was specific for cholecystitis (acute or chronic), and associated with SIN, acute cholecystitis on subsequent pathology report, and longer cholecystectomy operative times. Measurement of gallbladder dimensions as part of the assessment of cholecystitis may be advantageous.
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Affiliation(s)
- David Cannata
- University of Connecticut School of Medicine, Farmington, CT, United States of America
| | - Kyle A Chin
- University of Connecticut School of Medicine, Department of Emergency Medicine, Farmington, CT, United States of America
| | - Abeid Anslip
- University of Connecticut School of Medicine, Farmington, CT, United States of America
| | - Trent She
- Hartford Hospital, Department of Emergency Medicine, Hartford, CT, United States of America
| | - Seth Lotterman
- Hartford Hospital, Department of Emergency Medicine, Hartford, CT, United States of America
| | - Timothy Herbst
- Jefferson Radiology, East Hartford, CT, United States of America
| | - Meghan Kelly Herbst
- University of Connecticut School of Medicine, Department of Emergency Medicine, Farmington, CT, United States of America.
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Rana P, Pruthi H, Gupta P, Chhabra M, Soundararajan R, Singh S, Gulati A, Das CK, Yadav TD, Gupta V, Gupta P, Saikia UN, Dutta U, Sandhu M. Sonographic "Cervix Sign": A New Ancillary Sign of Gallbladder Neck Malignancy. J Clin Exp Hepatol 2023; 13:972-976. [PMID: 37975041 PMCID: PMC10643497 DOI: 10.1016/j.jceh.2023.05.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2022] [Accepted: 05/23/2023] [Indexed: 11/19/2023] Open
Abstract
Background The differentiation of benign and malignant gallbladder wall thickening is challenging. The purpose of this study is to evaluate a new sonographic sign, "cervix sign" for differentiation of benign and malignant gallbladder neck thickening. Methods This retrospective study comprised consecutive patients with gallbladder neck thickening who underwent sonography between August 2019 and December 2021. The presence of "cervix sign" was assessed by two radiologists independently. Results Sixty-five patients had gallbladder neck thickening (28 malignant and 37 benign). The sonographic "cervix sign" was present in 18 (64%) patients with malignant thickening and in only one (2.7%) patient with benign thickening (P = 0.0001). The mean wall thickness was greater, and symmetric wall thickening and liver metastases were more common in malignant thickening with "cervix sign" (without reaching statistical significance). There was substantial agreement (kappa = 0.78) between the two observers for the cervix sign. Conclusion Sonographic "cervix sign" is a useful ancillary feature of gallbladder neck cancer.
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Affiliation(s)
- Pratyaksha Rana
- Department of Radiodiagnosis and Imaging, Nehru Hospital, Postgraduate Institute of Medical Education and Research, Ground Floor, Sector 12, Chandigarh, 160012, India
| | - Himanshu Pruthi
- Department of Radiodiagnosis and Imaging, Nehru Hospital, Postgraduate Institute of Medical Education and Research, Ground Floor, Sector 12, Chandigarh, 160012, India
| | - Pankaj Gupta
- Department of Radiodiagnosis and Imaging, Nehru Hospital, Postgraduate Institute of Medical Education and Research, Ground Floor, Sector 12, Chandigarh, 160012, India
| | - Manika Chhabra
- Department of Radiodiagnosis and Imaging, Nehru Hospital, Postgraduate Institute of Medical Education and Research, Ground Floor, Sector 12, Chandigarh, 160012, India
| | - Raghuraman Soundararajan
- Department of Radiodiagnosis and Imaging, Nehru Hospital, Postgraduate Institute of Medical Education and Research, Ground Floor, Sector 12, Chandigarh, 160012, India
| | - Shravya Singh
- Department of Radiodiagnosis and Imaging, Nehru Hospital, Postgraduate Institute of Medical Education and Research, Ground Floor, Sector 12, Chandigarh, 160012, India
| | - Ajay Gulati
- Department of Radiodiagnosis and Imaging, Nehru Hospital, Postgraduate Institute of Medical Education and Research, Ground Floor, Sector 12, Chandigarh, 160012, India
| | - Chandan K. Das
- Department of Clinical Hematology and Medical Oncology, Nehru Hospital, Postgraduate Institute of Medical Education and Research, 4th Floor, Sector 12, Chandigarh, 160012, India
| | - Thakur D. Yadav
- Department of Surgical Gastroenterology, Nehru Hospital, Postgraduate Institute of Medical Education and Research, 5th Floor, Sector 12, Chandigarh, 160012, India
| | - Vikas Gupta
- Department of Surgical Gastroenterology, Nehru Hospital, Postgraduate Institute of Medical Education and Research, 5th Floor, Sector 12, Chandigarh, 160012, India
| | - Parikshaa Gupta
- Department of Cytology and Gynaecological Pathology, Postgraduate Institute of Medical Education and Research, 4th Floor, Research A Block, Sector12, Chandigarh, 160012, India
| | - Uma N. Saikia
- Department of Histopathology, Research A Block, Postgraduate Institute of Medical Education and Research, 5th Floor, Sector12, Chandigarh, 160012, India
| | - Usha Dutta
- Department of Gastroenterology, Advanced Gastroenterology Center, Nehru Hospital, Postgraduate Institute of Medical Education and Research, Ground Floor, Sector 12, Chandigarh, 160012, India
| | - Manavjit Sandhu
- Department of Radiodiagnosis and Imaging, Nehru Hospital, Postgraduate Institute of Medical Education and Research, Ground Floor, Sector 12, Chandigarh, 160012, India
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Halpern SA, Patrizio HA, Brace EJ, Wang S, Yuh JY, Patel DV, Morrison RG, Hall AJ, Falciani A, Deiling KA, Brolis NV. Anatomical Considerations for Gallbladder Sonography: A Cross-Sectional Study of CT Imaging by BMI Group. Cureus 2023; 15:e40557. [PMID: 37465802 PMCID: PMC10351329 DOI: 10.7759/cureus.40557] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/17/2023] [Indexed: 07/20/2023] Open
Abstract
Objective The purpose of this study was to establish an association between the body mass index (BMI) group and anatomical gallbladder position to aid novices in gallbladder sonography. Methods This was a cross-sectional, Strengthening the Reporting of Observational Studies in Epidemiology (STROBE)-compliant study that examined the association between gender and the BMI group with quantitative gallbladder position measurements from computed tomography (CT) scans. Results A quantitative analysis determined that the gallbladder was positioned relatively higher and oriented more horizontally within the abdomen of individuals with obese BMI than those with normal BMI (p < 0.001), irrespective of gender. Additionally, the gallbladder was more obstructed by the rib cage in individuals with obese BMI than those with normal BMI (p = 0.007 for females and p < 0.001 for males). The gallbladder was significantly more horizontal in overweight males than females (p < 0.001) and more obstructed by the rib cage in obese males than females (p = 0.013). Conclusion This association provides ultrasound novices knowledge for a more targeted approach in localizing the gallbladder and evidence to recommend an intercostal approach for gallbladder sonography in obese patients.
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Affiliation(s)
- Sophie A Halpern
- Clinical Education and Assessment Center, Rowan-Virtua School of Osteopathic Medicine, Stratford, USA
| | - Harrison A Patrizio
- Clinical Education and Assessment Center, Rowan-Virtua School of Osteopathic Medicine, Stratford, USA
| | - Eamonn J Brace
- Clinical Education and Assessment Center, Rowan-Virtua School of Osteopathic Medicine, Stratford, USA
| | - Shiyuan Wang
- Clinical Education and Assessment Center, Rowan-Virtua School of Osteopathic Medicine, Stratford, USA
| | - Jonathan Y Yuh
- Clinical Education and Assessment Center, Rowan-Virtua School of Osteopathic Medicine, Stratford, USA
| | - Dip V Patel
- Clinical Education and Assessment Center, Rowan-Virtua School of Osteopathic Medicine, Stratford, USA
| | - Ryan G Morrison
- Clinical Education and Assessment Center, Rowan-Virtua School of Osteopathic Medicine, Stratford, USA
| | - Arielle J Hall
- Clinical Education and Assessment Center, Rowan-Virtua School of Osteopathic Medicine, Stratford, USA
| | - Amerigo Falciani
- Clinical Education and Assessment Center, Rowan-Virtua School of Osteopathic Medicine, Stratford, USA
| | - Kathleen A Deiling
- Clinical Education and Assessment Center, Rowan-Virtua School of Osteopathic Medicine, Stratford, USA
| | - Nils V Brolis
- Clinical Education and Assessment Center, Rowan-Virtua School of Osteopathic Medicine, Stratford, USA
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Kasparian K, Christou CD, Petidis K, Doumas M, Giouleme O. Short vs long-course antibiotic therapy in adults with acute cholangitis: A systematic review, meta-analysis, and evidence quality assessment. World J Gastroenterol 2023; 29:3027-3039. [PMID: 37274798 PMCID: PMC10237100 DOI: 10.3748/wjg.v29.i19.3027] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2023] [Revised: 04/11/2023] [Accepted: 04/23/2023] [Indexed: 05/16/2023] Open
Abstract
BACKGROUND Acute cholangitis (AC) constitutes an infection with increased mortality rates in the past. Due to new diagnostic tools and therapeutic methods, the mortality of AC has been significantly reduced nowadays. The initial antibiotic treatment of AC has been oriented to the most common pathogens connected to this infection. However, the optimal duration of the antibiotic treatment of AC is still debatable.
AIM To investigate if shorter-course antibiotic treatments could be similarly effective to long-course treatments in adults with AC.
METHODS This study constitutes a systematic review and meta-analysis of the existing literature concerning the duration of antibiotic therapy of AC and an assessment of the quality of the evidence. The study was conducted in accordance with the recommendations of the Preferred Reporting Items for Systematic Review and Meta-Analyses. Fifteen studies were included in the systematic review, and eight were eligible for meta-analysis. Due to heterogeneous duration cutoffs, three study-analysis groups were formed, with a cutoff of 2-3, 6-7, and 14 d.
RESULTS A total of 2763 patients were included in the systematic review, and 1313 were accounted for the meta-analysis. The mean age was 73.66 ± 14.67 years, and the male and female ratio was 1:08. No significant differences were observed in the mortality rates of antibiotic treatment of 2-3 d, compared to longer treatments (odds ratio = 0.78, 95% confidence interval: 0.23-2.67, I2 = 9%) and the recurrence rates and hospitalization length were also not different in all study groups.
CONCLUSION Short- and long-course antibiotic treatments may be similarly effective concerning the mortality and recurrence rates of AC. Safe conclusions cannot be extracted concerning the hospitalization duration.
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Affiliation(s)
- Karampet Kasparian
- Clinic of Oncology, Gastroenterology and Hematology, Alfried Krupp Hospital, Essen 45131, Germany
- Second Propedeutic Department of Internal Medicine, Hippokration General Hospital, Aristotle University of Thessaloniki, Thessaloniki 54642, Greece
| | - Chrysanthos D Christou
- Department of Transplantation Surgery, Hippokration General Hospital, Aristotle University of Thessaloniki, Thessaloniki 54642, Greece
| | - Konstantinos Petidis
- Second Propedeutic Department of Internal Medicine, Hippokration General Hospital, Aristotle University of Thessaloniki, Thessaloniki 54642, Greece
| | - Michail Doumas
- Second Propedeutic Department of Internal Medicine, Hippokration General Hospital, Aristotle University of Thessaloniki, Thessaloniki 54642, Greece
| | - Olga Giouleme
- Second Propedeutic Department of Internal Medicine, Hippokration General Hospital, Aristotle University of Thessaloniki, Thessaloniki 54642, Greece
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Gupta P, Dutta U, Rana P, Singhal M, Gulati A, Kalra N, Soundararajan R, Kalage D, Chhabra M, Sharma V, Gupta V, Yadav TD, Kaman L, Irrinki S, Singh H, Sakaray Y, Das CK, Saikia U, Nada R, Srinivasan R, Sandhu MS, Sharma R, Shetty N, Eapen A, Kaur H, Kambadakone A, de Haas R, Kapoor VK, Barreto SG, Sharma AK, Patel A, Garg P, Pal SK, Goel M, Patkar S, Behari A, Agarwal AK, Sirohi B, Javle M, Garcea G, Nervi F, Adsay V, Roa JC, Han HS. Gallbladder reporting and data system (GB-RADS) for risk stratification of gallbladder wall thickening on ultrasonography: an international expert consensus. Abdom Radiol (NY) 2022; 47:554-565. [PMID: 34851429 DOI: 10.1007/s00261-021-03360-w] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2021] [Revised: 11/16/2021] [Accepted: 11/18/2021] [Indexed: 02/07/2023]
Abstract
The Gallbladder Reporting and Data System (GB-RADS) ultrasound (US) risk stratification is proposed to improve consistency in US interpretations, reporting, and assessment of risk of malignancy in gallbladder wall thickening in non-acute setting. It was developed based on a systematic review of the literature and the consensus of an international multidisciplinary committee comprising expert radiologists, gastroenterologists, gastrointestinal surgeons, surgical oncologists, medical oncologists, and pathologists using modified Delphi method. For risk stratification, the GB-RADS system recommends six categories (GB-RADS 0-5) of gallbladder wall thickening with gradually increasing risk of malignancy. GB-RADS is based on gallbladder wall features on US including symmetry and extent (focal vs. circumferential) of involvement, layered appearance, intramural features (including intramural cysts and echogenic foci), and interface with the liver. GB-RADS represents the first collaborative effort at risk stratifying the gallbladder wall thickening. This concept is in line with the other US-based risk stratification systems which have been shown to increase the accuracy of detection of malignant lesions and improve management.
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Affiliation(s)
- Pankaj Gupta
- Department of Radiodiagnosis and Imaging, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
| | - Usha Dutta
- Department of Gastroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Pratyaksha Rana
- Department of Radiodiagnosis and Imaging, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Manphool Singhal
- Department of Radiodiagnosis and Imaging, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Ajay Gulati
- Department of Radiodiagnosis and Imaging, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Naveen Kalra
- Department of Radiodiagnosis and Imaging, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Raghuraman Soundararajan
- Department of Radiodiagnosis and Imaging, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Daneshwari Kalage
- Department of Radiodiagnosis and Imaging, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Manika Chhabra
- Department of Radiodiagnosis and Imaging, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Vishal Sharma
- Department of Gastroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Vikas Gupta
- Department of Surgical Gastroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Thakur Deen Yadav
- Department of Surgical Gastroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Lileshwar Kaman
- Department of Surgery, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Santosh Irrinki
- Department of Surgery, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Harjeet Singh
- Department of Surgical Gastroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Yashwant Sakaray
- Department of Surgery, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Chandan Krishuna Das
- Haematology and Medical Oncology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Uma Saikia
- Department of Histopathology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Ritambhara Nada
- Department of Histopathology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Radhika Srinivasan
- Department of Cytology and Gynecological Pathology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Manavjit Singh Sandhu
- Department of Radiodiagnosis and Imaging, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Raju Sharma
- Department of Radiology, All India Institute of Medical Education and Research, New Delhi, India
| | - Nitin Shetty
- Department of Interventional Radiology, Tata Memorial Hospital, Mumbai, India
| | - Anu Eapen
- Department of Radiodiagnosis, Christian Medical College, Vellore, India
| | - Harmeet Kaur
- Division of Diagnostic Imaging, Department of Abdominal Imaging, MD Anderson Cancer Centre, Houston, TX, USA
| | - Avinash Kambadakone
- Abdominal Imaging, Harvard Medical School, Medical Director, Martha's Vineyard Hospital Imaging, Massachusetts General Hospital, Boston, USA
| | - Robbert de Haas
- Radiology, University Medical Center Groningen, Groningen, The Netherlands
| | - Vinay K Kapoor
- HPB Surgery, Mahatma Gandhi Medical College & Hospital, Jaipur, India
| | - Savio George Barreto
- Division of Surgery and Perioperative Medicine, Flinders Medical Centre, Bedford Park, SA, Australia
| | - Atul K Sharma
- Department of Medical Oncology, All India Institute of Medical Sciences, New Delhi, India
| | - Amol Patel
- Indian Naval Hospital Ship, Asvini, Mumbai, India
| | - Pramod Garg
- Department of Gastroenterology, All India Institute of Medical Sciences, New Delhi, India
| | - Sujoy K Pal
- Surgical Gastroenterology, All India Institute of Medical Sciences, New Delhi, India
| | - Mahesh Goel
- Gastrointestinal and HPB Surgery, Tata Memorial Hospital, Mumbai, India
| | - Shraddha Patkar
- Gastrointestinal and HPB Surgery, Tata Memorial Hospital, Mumbai, India
| | - Anu Behari
- HPB Surgery, Mahatma Gandhi Medical College & Hospital, Jaipur, India
| | - Anil K Agarwal
- GI Surgery and Liver Transplant, GB Pant Institute of Medical Education and Research and MAM College, New Delhi, India
| | - Bhawna Sirohi
- Medical Oncology, Apollo Proton Cancer Centre, Chennai, India
| | - Milind Javle
- Department of Gastrointestinal Medical Oncology, MD Anderson Cancer Centre, Houston, USA
| | | | - Flavio Nervi
- Department of Gastroenterology, School of Medicine, Pontificia Universidad Catolica de Chile, Santiago, Chile
| | - Volkan Adsay
- Department of Pathology, Koc University Hospitals, Istanbul, Turkey
| | - Juan Carlos Roa
- Department of Pathology, Pontificia Universidad Catolica de Chile, Santiago, Chile
| | - Ho-Seong Han
- Department of Surgery, College of Medicine, Seoul National University Bundang Hospital Seoul National University, Seongnam-si, South Korea
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Yang FJ, Kohen B, Sanapala S, Halperin M. A Potential Pitfall in POCUS of the Gallbladder: Beware of the Duodenum. POCUS JOURNAL 2022; 7:188-189. [PMID: 36896391 PMCID: PMC9983711 DOI: 10.24908/pocus.v7i2.15632] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
It is estimated that 20 million people in the United States have gallbladder disease. Of the patients who present to the Emergency Department (ED) with abdominal pain, 3-10% have acute cholecystitis. Point-of-care ultrasound (POCUS) evaluation of the biliary system is a valuable tool to diagnose gallbladder disease and can greatly expedite the diagnostic evaluation of patients. One source of error in POCUS of the gallbladder is imaging nearby structures that can mimic the gallbladder, such as the duodenum.
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Affiliation(s)
- Fan J Yang
- Jacobi Medical Center Bronx, New York USA
| | - Brian Kohen
- Memorial Regional Hospital Hollywood, Florida USA
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Pötter-Lang S, Ba-Ssalamah A, Bastati N, Messner A, Kristic A, Ambros R, Herold A, Hodge JC, Trauner M. Modern imaging of cholangitis. Br J Radiol 2021; 94:20210417. [PMID: 34233488 PMCID: PMC9327751 DOI: 10.1259/bjr.20210417] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/07/2022] Open
Abstract
Cholangitis refers to inflammation of the bile ducts with or without accompanying infection. When intermittent or persistent inflammation lasts 6 months or more, the condition is classified as chronic cholangitis. Otherwise, it is considered an acute cholangitis. Cholangitis can also be classified according to the inciting agent, e.g. complete mechanical obstruction, which is the leading cause of acute cholangitis, longstanding partial mechanical blockage, or immune-mediated bile duct damage that results in chronic cholangitis.The work-up for cholangitis is based upon medical history, clinical presentation, and initial laboratory tests. Whereas ultrasound is the first-line imaging modality used to identify bile duct dilatation in patients with colicky abdominal pain, cross-sectional imaging is preferable when symptoms cannot be primarily localised to the hepatobiliary system. CT is very useful in oncologic, trauma, or postoperative patients. Otherwise, magnetic resonance cholangiopancreatography is the method of choice to diagnose acute and chronic biliary disorders, providing an excellent anatomic overview and, if gadoxetic acid is injected, simultaneously delivering morphological and functional information about the hepatobiliary system. If brush cytology, biopsy, assessment of the prepapillary common bile duct, stricture dilatation, or stenting is necessary, then endoscopic ultrasound and/or retrograde cholangiography are performed. Finally, when the pathologic duct is inaccessible from the duodenum or stomach, percutaneous transhepatic cholangiography is an option. The pace of the work-up depends upon the severity of cholestasis on presentation. Whereas sepsis, hypotension, and/or Charcot's triad warrant immediate investigation and management, chronic cholestasis can be electively evaluated.This overview article will cover the common cholangitides, emphasising our clinical experience with the chronic cholestatic liver diseases.
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Affiliation(s)
- Sarah Pötter-Lang
- Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Vienna, Austria
| | - Ahmed Ba-Ssalamah
- Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Vienna, Austria
| | - Nina Bastati
- Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Vienna, Austria
| | - Alina Messner
- Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Vienna, Austria
| | - Antonia Kristic
- Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Vienna, Austria
| | - Raphael Ambros
- Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Vienna, Austria
| | - Alexander Herold
- Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Vienna, Austria
| | - Jacqueline C Hodge
- Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Vienna, Austria
| | - Michael Trauner
- Division of Gastroenterology and Hepatology, Department of Internal Medicine III, Medical University of Vienna, Vienna, Austria
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Dobruch-Sobczak K, Jędrzejowski M, Jakubowski W, Trzebińska A. Errors and mistakes in ultrasound diagnostics of the thyroid gland. J Ultrason 2014; 14:61-73. [PMID: 26672970 PMCID: PMC4579735 DOI: 10.15557/jou.2014.0006] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2014] [Revised: 03/10/2014] [Accepted: 03/18/2014] [Indexed: 11/25/2022] Open
Abstract
Ultrasound examination of the thyroid gland permits to evaluate its size, echogenicity, margins, and stroma. An abnormal ultrasound image of the thyroid, accompanied by other diagnostic investigations, facilitates therapeutic decision-making. The ultrasound image of a normal thyroid gland does not change substantially with patient's age. Nevertheless, erroneous impressions in thyroid imaging reports are sometimes encountered. These are due to diagnostic pitfalls which cannot be prevented by either the continuing development of the imaging equipment, or the growing experience and skill of the practitioners. Our article discusses the most common mistakes encountered in US diagnostics of the thyroid, the elimination of which should improve the quality of both the ultrasound examination itself and its interpretation. We have outlined errors resulting from a faulty examination technique, the similarity of the neighboring anatomical structures, and anomalies present in the proximity of the thyroid gland. We have also pointed out the reasons for inaccurate assessment of a thyroid lesion image, such as having no access to clinical data or not taking them into account, as well as faulty qualification for a fine needle aspiration biopsy. We have presented guidelines aimed at limiting the number of misdiagnoses in thyroid diseases, and provided sonograms exemplifying diagnostic mistakes.
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Affiliation(s)
- Katarzyna Dobruch-Sobczak
- Zakład Diagnostyki Ultrasonograficznej i Mammografii, Mazowiecki Szpital Bródnowski, Warszawa, Polska
| | | | - Wiesław Jakubowski
- Zakład Diagnostyki Obrazowej, II WL, Warszawski Uniwersytet Medyczny, Warszawa, Polska
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Bile Duct Strictures Caused by Solid Masses: MR in Differential Diagnosis and as a Prognostic Tool to Plan the Endoscopic Treatment. Gastroenterol Res Pract 2013; 2013:729279. [PMID: 24302932 PMCID: PMC3835808 DOI: 10.1155/2013/729279] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2013] [Accepted: 09/24/2013] [Indexed: 01/27/2023] Open
Abstract
The aim of the study was to assess how realiable is differential diagnosis and prognosis for endoscopic treatment with MR signal characteristics as the qualitative parameter and magnetic resonance cholangiopancreatography (MRCP) images in cases of bile duct obstructions caused by solid masses. Material and Methods. Retrospective study of MR and MRCP images in 80 patients (mean age 58 ys) was conducted. Mean signal intensity ratio (SIR) from planar MR images and MRCP linear measurements were compared between benign and malignant lesions and in groups including the size and number of stents placed during ERCP (< 10 F <) in 51 cases in which ERCP was performed. Results. Significantly higher SIR values were encountered in malignant lesions in T2W images (r = 0,0003) and STIR T2W images (r = 0,0002). Malignant lesions were characterised by longer strictures (r = 0,0071) and greater proximal biliary duct dilatation (r = 0,0024). High significance for predicting ERCP conditions was found with mean SIR in STIR T2W images and stricture length. Conclusion. Probability of malignancy of solid lesions obstructing biliary duct increased with higher SIR in T2W images and with longer strictures. Passing the stricture during ERCP treatment was easier and more probable in cases of shorter strictures caused by lesions with higher SIR in STIR T2W images.
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