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Abdomen » Hepatobiliary
Thickened Gallbladder Wall in Hepatitis A
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Author(s) :
Danilo Sirigu, MD
 
Presentation A 32 year-old man presents with right upper quadrant pain, fever, abnormal liver function tests, and a negative sonographic Murphy’s sign.
 
 
Caption: Real time scan right upper quadrant
Description: Liver echo pattern is accentuated in brightness with prominence of portal vein radicle walls suggesting acute hepatitis. Gallbladder is contracted and exhibits thickened striated walls.
 
Differential Diagnosis Acute cholecystitis
Thickened GB wall in Hepatitis A
Thickening secondary to other inflammatory or metabolic disease
 
Final Diagnosis Gallbladder wall thickening secondary to Hepatitis A
 
Discussion In acute hepatitis ultrasound findings are variable but the predominant findings are accentuated brightness and more extensive demonstration of the portal vein radicle walls and overall decreased echogenicity of the liver, giving rise to the starry night pattern.  In this case the increased visibility of the portal vein radicles is the most notable change seen in the liver

Transabdominal ultrasound showed a contracted gallbladder with a thickened striated wall with alternating echogenic and hypoechoic layers.  The alternating of echogenic and hypoechoic layers is typical of an edematous wall in hepatitis A.  This appearance alone is sufficient to suggest the diagnosis of hepatitis A in the correct clinical situation, although other conditions can cause edema of the wall of the gall bladder.  The finding of gallbladder wall thickening itself, however, is non-specific and may be associated with a wide range of gallbladder diseases and extracholecystic pathologic conditions.  Other causes of gallbladder wall thickening include alcoholic liver disease with hypoproteinemia, heart failure, renal disease, acute pancreatitis, peritonitis, multiple myeloma, gallbladder cancer or adenomyomatosis to list only a few.

The pathogenesis of gallbladder wall thickening in viral hepatitis is uncertain, but it probably is secondary to inflammatory process.

Morphological and motility changes of the gallbladder in early acute viral hepatitis are reversible and disappear 5-10 days after initiation of therapy.

An excellent review of gallbladder wall thickening may be found at
http://www.radiologyassistant.nl/en/43a0746accc5d
 
Case References Giorgio A, Ambroso P, Fico P, et al. Ultrasound evaluation of uncomplicated and complicated acute viral hepatitis. J Clin Ultrasound 1986; 14:675–679.
 
Juttner HU, Ralls PW, Quinn MF, et al. Thickening of the gallbladder wall in acute hepatitis: ultrasound demonstration. Radiology 1982; 142:465–466.

Shlaer WJ, Leopold GR, Scheible FW. Sonography of the thickened gallbladder wall: a nonspecific finding. AJR Am J Roentgenol. 1981 Feb;136(2):337-9.

Kurtz AB, Rubin CS, Cooper HS, Nisenbaum HL, Cole-Beuglet C, Medoff J, Goldberg BB. Ultrasound findings in hepatitis. Radiology. 1980 Sep;136(3):717-23.