PubMed · 14393425
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E WILDHIRT. 1955-05-27. [Liver--gallbladder].. https://pubmed.ncbi.nlm.nih.gov/14393425/
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Idiopathic myelofibrosis is often associated with myeloid metaplasia (extramedullary haemopoiesis) in the spleen and liver. However, the gall bladder is an extremely unusual site for it to occur. A 59 year old man with myelofibrosis, who underwent cholecystectomy for chronic cholecystitis, showed myeloid metaplasia in his gall bladder. Pathologically, this may lead to diagnostic difficulties.
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The aim of the study was to assess the value of harmonic imaging in US evaluation of gall bladder concrements. The material comprised 40 patients with pathology of gall bladder diagnosed in US examination. 21 patients from this group with gall bladder concrements diagnosed in US was included into the study. In each patient supplementary US examination in the harmonic mode was performed. In three patients the deposits were localized in the cervix of the gallbladder. In two of them the acoustic shadow was seen only on THI images. In one patient the fibrotic gall bladder was found. In seven cases the concrements were sharper and more distinctly visible on harmonic images and acoustic shadow was more evident in eight. In five cases in the standard mode the presence of inspissated bile was found in gall bladder, but examination in the harmonic mode excluded the diagnosis in four of them. In the harmonic mode the level of artifacts generated by the body wall is reduced and contrast resolution is increased due to reduction in the noise level. The visualization of gallbladder is improved in the harmonic mode. The assessment of gallbladder stones in the harmonic mode is easier because: 1) images of the gall bladder lumen are clearer due to the reduced level of artifacts; 2) the resolution and contrast between the concrements and the bile are increased; 3) the acoustic shadow is more evident on harmonic images. Diagnosis of concrements localized in the gall bladder cervix is especially improved in the harmonic mode. Differentiation of solitary and multiple concernments is also facilitated by harmonic imaging.