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.

Probe Placement