E4762. Gallbladder Ultrasound On-Call Pitfalls: Lessons Learned From Emergency Imaging
Authors
Miltiadis Tembelis;
NYU Langone Hospital - Long Island
Aranz Khalilollahi;
NYU Langone Hospital - Long Island
Evan Madianos;
NYU Langone Hospital - Long Island
Margarita Revzin;
Yale School of Medicine
Douglas Katz;
NYU Langone Hospital - Long Island
Background
Right upper quadrant ultrasounds are encountered multiple times per on-call shift by radiologists. It is not uncommon for these right upper quadrant ultrasounds to be complex or present the radiologist with incidental findings that need appropriate recommendations for follow-up.
Educational Goals / Teaching Points
- Present a series of recent problematic on-call ultrasound gallbladder cases, with an emphasis on emergency imaging and quality assurance issues, and demonstrate correlative imaging, with prior and subsequent ultrasound and other relevant cross-sectional imaging examinations. - Briefly review the current, relevant clinical and imaging literature on these topics. - Provide some helpful advice/lessons learned from our recent clinical experience to help our colleagues stay out of trouble with sonographic interpretation of the gallbladder while on call.
Key Anatomic/Physiologic Issues and Imaging Findings/Techniques
-Polyps: what to do with them, what’s the real evidence? – Adenomyomatosis. - Wall thickening: differential and management. - Hemorrhage: intramural and intraluminal. - Acute versus subacute versus chronic cholecystitis, or a combination of these - how to sort out? - Less common ultrasound findings of acute cholecystitis. - Roles of US versus CT versus MRI. - Pancreatitis versus cholecystitis or both. - COVID and the gallbladder. - Gallbladder cancer. - Other unexpected or incidental findings.
Conclusion
For ‘bread and butter’ examinations, such as a right upper quadrant/gallbladder ultrasound, a nontrivial minority of patients can be substantially problematic for a variety of reasons. Knowledge of gallbladder pathology, complications of the pathology, alternative diagnoses, and common incidentals can help interpretating radiologist sort out complex examinations.
