Porcelain Gallbladder

This week’s image of the week is brought to you by the residents on the ultrasound rotation this month, Kyle Brown and Kimberly Clark.  They identified a very rare and interesting ulltrasonographic finding, a porcelain gallbladder. 

The wall of the gallbladder is calcified and therefore casts a sonographic shadow. This brings up an important point regarding the imaging of the gallbladder. Gallbladder scanning is as much about looking for the secondary signs (such as sonographic shadowing) as it about identifying the appropriate landmarks (common bile duct, port vein, main lobar fissure). We encourage you to try to train yourself to look for the shadowing by scanning the far field portion of the image for shadows. Much like the WES (Wall-Echo-Shadow) sign and the porcelain GB, subtle smaller gallstones may only be identified by the shadow they cast. 

WES

 

Gallbladder Landmarks

Probe Placement

Unfortunately, there is no set convention for probe placement in gallbladder scanning. The gallbladder is a mobile organ and can shift in position. We suggest that you start out in the right mid-claviclular line just below the costal margin with the indicator pointing to the patient right shoulder.  Having the patient lie in the left lateral decubitus position can often displace bowel gas out and enable you to get a better view of the gallbladder.