Summary
A total of 743 patients affected by various gastrointestinal disorders were examined by ultrasound. The presence in the gallbladder bile of low-level echoes (LLE) was observed in 56 (7.5%). Twenty-six of these patients had surgery: 24 underwent cholecystectomy for important biliary-like painful symptomatology, and 2 had cephalopancreatectomy for pancreatic head carcinoma. Both macro- and microscopic controls of the bile were carried out in all 26 patients. In 20 cases, only microscopic cholesterol crystals and calcium bilirubinate granules were observed in the bile. The microscopic evidence of these crystals was associated in four cases with macroscopic evidence of so-called “biliary sludge” and in four cases with macroscopic evidence of highly viscous bile. In the other 6 cases these crystals were associated with the presence of cholesterol stones. The authors consider that the observation of LLE in the gallbladder bile is an important index of the presence of cholesterol crystals and/or calcium bilirubinate granules. These LLE can assume polymorphic aspects, described by the authors, which may simulate other pathologies and lead to incorrect echographic diagnosis. The high incidence of LLE in an alithiasic population (5.1%), together with the elevated frequency, according to the authors, of association of these echoes with a painful biliary-like symptomatology (52.6%), underlines the diagnostic importance of an accurate ultrasound investigation in this type of pathology.
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References
Allen B, Bernhoft R, Blanckaert N, Svanvik J, Filly R, Gooding G, Way L (1981) Sludge is calcium bilirubinate associated with bile stasis. Am J Surg 141: 51–56
Anastasi BB, Sutherland GR (1981) Biliary sludge — ultrasonic appearance simulating neoplasm. Br J Radiol 54: 679–681
Blais J, Kunstlinger F, Bokobsa J, Sassoon C, Baussan C, Doyon D (1982) Etude échographique du liquide échogène intra-vésiculaire. J Radiol 63: 85–90
Carey MC, Small DM (1978) The physical chemistry of cholesterol solubility in bile. Relationship to gallstone formation and dissolution in man. J Clin Invest 61: 998
Conrad MR, Janes JO, Dietchy J (1979) Significance of low level echoes within the gallbladder. AJR 132: 967–972
Cunningham JJ (1976) In vitro gray scale echography of proteinlipid fluid collections in liver tissue. J Clin Ultrasound 4: 255–258
Cunningham JJ, Wooten W, Cunninghal MA (1976) Gray scale echography of soluble protein and protein aggregate fluid collection (in vitro study). J Clin Ultrasound 4: 417–419
Darlas Y, Bouvard N (1981) A study of the biliary sludge in B mode ultrasonography: present update and synthesis. Ultrasons 2: 115–121
Fakhry J (1982) Sonography of tumefactive biliary sludge. AJR 139: 717–719
Filly RA, Moss AA, Way LW (1979) In vitro investigation of gallstone shadowing with ultrasound tomography. J Clin Ultrasound 7: 255–262
Filly RA, Allen B, Minton MJ, Bernhoft R, Way LW (1980) In vitro investigation of the origin of echoes within biliary sludge. J Clin Ultrasound 8: 193–200
Filly RA, Sommer FG, Minton MJ (1980) Characterization of biological fluids by ultrasound and computed tomography. Radiology 134: 167–171
Glancy JJ (1979) Fluid-filled echogenic epidermoid cyst of the spleen. J Clin Ultrasound 7: 301
Glancy JJ, Goddard J, Pearson DE (1980) In vitro demonstration of cholesterol crystals' high echogenicity relative to protein particles. J Clin Ultrasound 8: 27–29
Juniper K, Burson EN (1957) Biliary tract studies. The significance of biliary crystals. Gastroenterology 32: 175–211
Ruhe AHMD, Zachman JPMD, Mulder BDRT, Rime AERT (1979) Cholesterol polyps of the gallbladder: ultrasound demonstration. J Clin Ultrasound 7: 386–388
Thurber LA, Cooperberg PL, Clement JG, Lyons EA, Gramiak R, Cunningham J (1979) Echogenic fluid: a pitfall in the ultrasonographic diagnosis of cystic lesions. J Clin Ultrasound 7: 273–278
White E, Filly RA (1980) Cholesterol crystals as the source of both diffuse and layered echoes in a cystic ovarian tumour. J Clin Ultrasound 8: 241
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Boscaini, M., Magnani, G., Mandetta, S. et al. Morphological appearance of low-level echoes in the gallbladder. Surg Endosc 1, 41–49 (1987). https://doi.org/10.1007/BF00703087
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DOI: https://doi.org/10.1007/BF00703087