[Ultrasonics in the diagnosis of hyperplastic cholecystoses of focal and segmental extension type]

Abstract

The authors describe the sonographic (US) patterns of hyperplastic cholecystoses observed from January 1983 to April 1987 - 39 cases of focal extension and 12 of segmental extension--and confirm the higher sensibility of US versus oral cholecystography. Sonography (SG) allows a straight visualization of the gallbladder wall and its lesions, both in case of limited thickening of the wall (focal cholecystosis) and in case of more extensive thickening (segmental cholecystosis). To cholecystographic findings of focal lesions, SG gives additional information, adding a fundamental diagnostic element: the lack of acoustic shadowing distal to the nodular masses. Nonetheless, SG does not allow a discrimination between focal cholesterolosis and adenomyomatosis, except for particular cases, such as multiple nodular masses, and coexistence with the "comet tail" pattern--the latter due to parietal deposits of cholesterol. Furthermore, the differential diagnosis of focal cholecystoses includes some neoplasms of the gallbladder, and gallstones stuck to the wall, with no acoustic shadowing. In segmental cholecystoses, the direct evaluation of the entity and extension of the wall thickening remains a fundamental diagnostic element, even though such a morphologic detail is often integrated by the functional relieve of hypercontractility of the gallbladder wall after a fatty meal (both oral cholecystography and SG demonstrate it).