Dynamic cholecystosonography of the contracted gallbladder: the double-arc-shadow sign

Raptopoulos, Vassilios; D'Orsi, C. J.; Smith, Edward H.; Reuter, Karen L.; Moss, Lawrence J.; Kleinman, Paul K.

doi:10.2214/ajr.138.2.275

Cited by 25 publications

(7 citation statements)

References 2 publications

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“…This finding termed a junctional fold can be differentiated from wall echo complex. 5 Wall echo shadows being a diagnostic sign of cholelithiasis on ultrasonography, surgeons are not aware of the clinical implications of this sign for laparoscopic cholecystectomy. Wall echo shadow sign is most likely to produce the inflammation of gall bladder either acute cholecystitis or acute or acute on chronic cholecystitis.…”

Section: Introductionmentioning

confidence: 99%

Laparoscopic cholecystectomy in wall echo complex gall stone disease: a study

Arora

2017

Int Surg J

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Background: There are so many subtitles for difficult laproscopic cholecystectomy. Stone in the neck of gall bladder constitutes one of the entities. Wall echo complex is an ultrasound terminology used for cholelithiasis. It has three layers, first the pericholecystic fat between gallbladder and liver. Second layer consists of gall bladder wall. The third layer consists of echogenic stone itself. Wall echo complex is one of the entities which constitute difficult laproscopic cholecystectomy. Wall echo complex in the neck of the gall bladder is particularly difficult gall bladder where the conversion rates are high.Methods: The study was conducted in Department of Surgery. Standard four port cholecystectomy was done in 50 patients. Wall echo complex in all these patients was reported by ultrasonologist. Difficulties in operating wall echo complex cholelithiasis consisted of dissection of neck of gall bladder due to adhesions and a sleeve of fat covering the calot’s triangle. The difficulty of wall echo cholelithiasis was managed by opening the neck of gall bladder and evacuating the stones into a separate latex bag. By this procedure the difficult wall echo cholelithiasis was managed in all cases. Ligaclips were used for ligation of cystic duct, cystic artery and pericholecystic veins.Results: The evacuation of stones from the neck of gall bladder led to an easy cholecystectomy in 46 patients while the four patients had conversion to open cholecystectomy.Conclusions: Wall echo complex although an ultrasonologists entity but is a difficult gall bladder for laproscopic cholecystectomy.

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Section: Introductionmentioning

confidence: 99%

Laparoscopic cholecystectomy in wall echo complex gall stone disease: a study

Arora

2017

Int Surg J

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“…They feel that the lucent line represents relatively low reflectivity of the gallbladder wall and therefore named this triad the "WES" sign (wall-echo-shadow). The WES sign has also been recognized as a reliable indicator of gallstones imaged with real-time instrumentation [5]. When we reviewed the images of the patients in our series, we found that 14 of 25 patients clearly showed the WES triad and 11 did not.…”

Section: Discussionmentioning

confidence: 64%

Strong acoustical shadowing from the gallbladder bed: Ultrasonic-pathologic correlation

Cunningham

Carswell

1982

Gastrointest Radiol

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We reviewed a series of 25 patients whose cholecystosonograms showed ultrasonic nonvisualization of the gallbladder, high-amplitude echoes in the region of the gallbladder bed, and strong acoustical shadowing. These 3 findings have previously been thought to be a reliable indication of a small contracted gallbladder filled with stones. In our series, all 25 such patients did not have gallstones, but the size and number of the calculi were highly variable. Only a small minority of our patients had a contracted gallbladder in most, the volume of the gallbladder was either normal or greater than normal. Ultrasonic nonvisualization of the gallbladder accompanied by acoustical shadowing was not a reliable indicator of gallbladder wall thickness in our series. Of 25 patients, 20 had either a normal gallbladder wall or only slight thickening. When we reviewed our images to determine how many fit the "WES" criteria thought to be a specific manifestation of a contracted gallbladder filled with stones, we found that 14 of 25 individuals clearly showed this group of ultrasonic findings. We could not, however, correlate the presence or absence of the 'WES' triad with the number and size of stones, the gallbladder volume, or thickness of the gallbladder wall.

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“…In the adult, identification of a wall-echo-shadow sign is considered diagnostic, distinguishing a stonefilled gallbladder from competing diagnoses, such as liver calcification, porcelain gallbladder, emphysematous cholecystitis, or a loop of bowel. 11,12 In fetal imaging as well, gallstones should be considered in the differential diagnosis for a circumscribed or linear grouping of echogenic foci in the right upper quadrant, even if the gallbladder wall and bile are not apparent on initial imaging. The location and orientation of echogenic foci in the right upper quadrant should be assessed critically to determine if these lie at the expected position of the gallbladder.…”

Section: Discussionmentioning

confidence: 99%