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Biliary Disease

Biliary Disease. Gallbladder and Biliary Tree. Imaging Studies Available X-ray Computed tomography Radioisotope scan ( hepatobiliary scan) Ultrasound: the most sensitive study for gallstone. Gallstones. 81% consist of cholesterol and are radiolucent ( cannot be seen on plain films)

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Biliary Disease

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  1. Biliary Disease

  2. Gallbladder and Biliary Tree • Imaging Studies Available • X-ray • Computed tomography • Radioisotope scan (hepatobiliary scan) • Ultrasound: the most sensitive study for gallstone

  3. Gallstones • 81% consist of cholesterol and are radiolucent (cannot be seen on plain films) • 19% contain calcium and are radio-opaque (can be seen on plain films)

  4. Gallstones • Size: can be very small (1-2 mm) to very large (several cm) • Shape: single stone – round, large • Multiple stones – small, faceted

  5. Gallstones • Complications include • Obstruction of bile duct: commonly cystic duct and common bile duct • Cholecystitis (infection/ inflammation of the gallbladder) • Abscess (complication of cholecystistis) • Perforation: • peritonitis, inflammation infection of peritoneum • gallstone ileus, stone erodes into GI tract and causes obstruction

  6. Gallbladder • Ultrasound • Stones all appear ECHOGENIC (white) • May be either radiolucent or radio-opaque • Beyond stone is an acoustic shadow • Bile is HYPOECHOIC(black) • Polyps, neoplasm typically are isoechoic (equal echo density) to adjacent soft tissues

  7. Gallstones • AP abdomen • Several facetted calcified densities • Dense rim less dense center • Separate from renal calculi and costocartilage by different positions • Use oblique films, gallbladder anterior so move away from spine

  8. Gallstones • Ultrasound upper abdomen • Longitudinal scan • Round echogenic structures in gallbladder • Acoustic shadowing

  9. Dilation of Bile Ducts • Causes include • Stone (most common) • Carcinoma

  10. Dilated Common Bile Duct • Longitudinal US through liver hilum • Typical double channel sign • Dilated common bile duct (blue arrow) anterior to portal vein (red arrow) • Duct usually smaller than vein • Stone(not seen) distal in duct

  11. Bile Duct Dilatation • Axial CT mid-abdomen • Dilated common bile duct (arrowhead) • Dilated intrahepatic ducts • Round fluid structure anterior to kidney is distended gallbladder

  12. Common Bile Duct Stone • Axial imaging lower than prior example • High density structure obstructing calculi (arrow) • Large round area gallbladder

  13. HIDA Imaging • Radionuclide targeted to hepatocytes • Non filling of the common bile duct or gall bladder indicates obstructive process

  14. Acute Cholecystitis No filling of the gallbladder 60 minutes after injection of isotope Rapid accumulation within the liver and bile ducts with spill into the doudenum

  15. Bile Leak Ida Scan Accumulation of isotope outside of the biliary tree

  16. MR Cholangiography Stone • Emerging technology • Visualize stone as a filling defect in the common duct (blue arrow)

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