Gallbladder wall thickening= cholecystitis?
This week’s image of the week is once again courtesy of Drs Pitts and Akther. Both residents are completing their ultrasound month, and we have enjoyed their unique contributions to the world of ultrasound. The images are of a gallbladder in a patient with ascites and ESRD.
The images show a dilated gallbladder wall with a “tram track” appearance. The patient had no signs or symptoms of cholecystitis or billary colic. Gallbladder wall dilation may be secondary to multiple different disease process including: renal failure, ascites, hepatitis, hypoalbuminemia, CHF, HIV/AIDS, adenomyomatosis, and multiple myeloma. The take home message is that ultrasound is an adjunct to your history and physical exam and should not override your clinical gestalt.
The images show a dilated gallbladder wall with a “tram track” appearance. The patient had no signs or symptoms of cholecystitis or billary colic. Gallbladder wall dilation may be secondary to multiple different disease process including: renal failure, ascites, hepatitis, hypoalbuminemia, CHF, HIV/AIDS, adenomyomatosis, and multiple myeloma. The take home message is that ultrasound is an adjunct to your history and physical exam and should not override your clinical gestalt.
Probe Placement
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BalasHapusFascinating case and great teaching point on the limitations of relying solely on imaging. The “tram track” sign can easily lead to overdiagnosis if not correlated with clinical findings. It's a strong reminder that surgery should never be based on imaging alone. When intervention is necessary, especially in high-risk or complex patients, consulting the best surgeon for gallbladder removal ensures that decisions are precise, evidence-based, and patient-centered. Kudos to Drs Pitts and Akther for highlighting such a nuanced case.
BalasHapus