391 ULTRASOUND CLINICS ELSEVIER SAUNDERS sound clin2(2007391-413 Ultrasound Imaging of the Biliary Tract Deborah」. Rubens,MD Inflammatory disorders: cholecystitis Benign neoplasms of the gallbladder The Sonographic Murphy's Sign Malignant neoplasms of the gallbladder Gallstones Biliary ducts Gallbladder wall thickening a Ultrasound diagnosis of biliary ductal and pericholecystic fluid dilatation Acute acalculous cholecystitis Diagnosis of biliary obstruction Complicated cholecystitis n Causes of biliary obstruction Choledocholithiasis Gallbladder perforation Ne。 plasm Inflammatory disorders of the biliary ducts Chronic cholecystitis Biliary air and biliary necrosis Noninflammatory non-neoplastic gallbladder disorders: the hyperplastic References cholecystoses-cholesterolosis and Patients who have disease of the biliary tract inflammation of the gallbladder wall. There may ommonly present with acute right upper quadrant or may not be associated infection and necrosis pain, nausea or vomiting, mid-epigastric pain, and/ Ninety to ninety-five percent of all cases of acute or jaundice. Etiologies include inflammation with cholecystitis are caused by obstruction of either or without infection, noninflammatory disorders, the cystic duct or the neck of the gallbladder by gal and benign or malignant neoplasms of the gallblad- stones 1. Acute cholecystitis, however, occurs in der or bile ducts. Ultrasound(us) is now accepted only approximately 20% of patients who have gall as the initial imaging modality of choice for the stones [2 This means that most gallstones are work-up of suspected biliary tract disease. asymptomatic. Thus, right upper quadrant pain in This article reviews the most common diseases of a patient who has gallstones often is caused by some- the gallbladder and bile ducts, strategies for evaluat- thing other than acute cholecystitis 3 Further- ing the biliary tract with ultrasound, and specific more, studies have shown that only 20%-35% of imaging patterns that aid in diagnosis patients presenting with right upper quadrant pain are subsequently shown to have acute cholecystitis Inflammatory disorders: cholecystitis 11, 2 Therefore, it is important to understand the sensitivity and specificity of common US findings Acute cholecystitis most often occurs secondary in patients who have acute cholecystitis, because to obstruction of the gallbladder with resultant the presence of gallstones alone is not adequate to University of Rochester Medical Center, Department of Imaging Sciences, 601 Elmwood Avenue, Rochester NY14642-8648,USA E-mail address. deborah rubens@urmc rochester edu 1556-858X/07/S-see front matter e 2007 Elsevier Inc. All rights reserved doi:10.1016/cut200708.00Ultrasound Imaging of the Biliary Tract Deborah J. Rubens, MD Patients who have disease of the biliary tract commonly present with acute right upper quadrant pain, nausea or vomiting, mid-epigastric pain, and/ or jaundice. Etiologies include inflammation with or without infection, noninflammatory disorders, and benign or malignant neoplasms of the gallblad￾der or bile ducts. Ultrasound (US) is now accepted as the initial imaging modality of choice for the work-up of suspected biliary tract disease. This article reviews the most common diseases of the gallbladder and bile ducts, strategies for evaluat￾ing the biliary tract with ultrasound, and specific imaging patterns that aid in diagnosis. Inflammatory disorders: cholecystitis Acute cholecystitis most often occurs secondary to obstruction of the gallbladder with resultant inflammation of the gallbladder wall. There may or may not be associated infection and necrosis. Ninety to ninety-five percent of all cases of acute cholecystitis are caused by obstruction of either the cystic duct or the neck of the gallbladder by gall￾stones [1]. Acute cholecystitis, however, occurs in only approximately 20% of patients who have gall￾stones [2]. This means that most gallstones are asymptomatic. Thus, right upper quadrant pain in a patient who has gallstones often is caused by some￾thing other than acute cholecystitis [3]. Further￾more, studies have shown that only 20%–35% of patients presenting with right upper quadrant pain are subsequently shown to have acute cholecystitis [1,2]. Therefore, it is important to understand the sensitivity and specificity of common US findings in patients who have acute cholecystitis, because the presence of gallstones alone is not adequate to ULTRASOUND CLINICS Ultrasound Clin 2 (2007) 391–413 University of Rochester Medical Center, Department of Imaging Sciences, 601 Elmwood Avenue, Rochester, NY 14642-8648, USA E-mail address: deborah_rubens@urmc.rochester.edu - Inflammatory disorders: cholecystitis - The Sonographic Murphy’s Sign - Gallstones - Gallbladder wall thickening and pericholecystic fluid - Acute acalculous cholecystitis - Complicated cholecystitis - Gangrenous cholecystitis - Gallbladder perforation - Emphysematous cholecystitis - Chronic cholecystitis - Noninflammatory non-neoplastic gallbladder disorders: the hyperplastic cholecystoses—cholesterolosis and adenomyomatosis Benign neoplasms of the gallbladder Malignant neoplasms of the gallbladder - Biliary ducts - Ultrasound diagnosis of biliary ductal dilatation - Diagnosis of biliary obstruction - Causes of biliary obstruction Choledocholithiasis Neoplasm - Inflammatory disorders of the biliary ducts - Biliary air and biliary necrosis - Summary - References 391 1556-858X/07/$ – see front matter ª 2007 Elsevier Inc. All rights reserved. doi:10.1016/j.cult.2007.08.007 ultrasound.theclinics.com