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Echogenic Bile
Jade Wong-You-Cheong, MBChB, MRCP, FRCR
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KEY FACTS

  • Terminology

    • Imaging

      • Top Differential Diagnoses

        • Clinical Issues

          • Diagnostic Checklist

            TERMINOLOGY

            • Synonyms

              • Biliary sludge, tumefactive sludge, biliary sand, microlithiasis
            • Definitions

              • Presence of particulate material (calcium bilirubinate/phosphate or carbonate crystals with cholesterol monohydrate crystals) in bile
                • Larger particles (1-3 mm) are microliths, which may become nidus for gallstones

            IMAGING

            • General Features

              • Ultrasonographic Findings

                • CT Findings

                  • MR Findings

                    • Nonvascular Interventions

                      • Imaging Recommendations

                        DIFFERENTIAL DIAGNOSIS

                          PATHOLOGY

                          • General Features

                            • Gross Pathologic & Surgical Features

                              CLINICAL ISSUES

                              • Presentation

                                • Demographics

                                  • Natural History & Prognosis

                                    • Treatment

                                      DIAGNOSTIC CHECKLIST

                                      • Consider

                                        • Image Interpretation Pearls

                                          Selected References

                                          1. Knab LM et al: Cholecystitis. Surg Clin North Am. 94(2):455-70, 2014
                                          2. O'Connell K et al: Bile metabolism and lithogenesis. Surg Clin North Am. 94(2):361-75, 2014
                                          3. Gore RM et al: Gallbladder imaging. Gastroenterol Clin North Am. 39(2):265-87, ix, 2010
                                          4. Stinton LM et al: Epidemiology of gallstones. Gastroenterol Clin North Am. 39(2):157-69, vii, 2010
                                          5. Venneman NG et al: Pathogenesis of gallstones. Gastroenterol Clin North Am. 39(2):171-83, vii, 2010
                                          6. Smith EA et al: Cross-sectional imaging of acute and chronic gallbladder inflammatory disease. AJR Am J Roentgenol. 192(1):188-96, 2009
                                          7. Pandya R et al: Hemorrhagic cholecystitis as a complication of anticoagulant therapy: role of CT in its diagnosis. Abdom Imaging. 33(6):652-3, 2008
                                          8. Jüngst C et al: Gallstone disease: Microlithiasis and sludge. Best Pract Res Clin Gastroenterol. 20(6):1053-62, 2006
                                          9. Choi D et al: Sonographic findings of active Clonorchis sinensis infection. J Clin Ultrasound. 32(1):17-23, 2004
                                          10. Gremmels JM et al: Hemorrhagic cholecystitis simulating gallbladder carcinoma. J Ultrasound Med. 23(7):993-5, 2004
                                          11. Green MH et al: Haemobilia. Br J Surg. 88(6):773-86, 2001
                                          12. Nishiwaki M et al: Posttraumatic intra-gallbladder hemorrhage in a patient with liver cirrhosis. J Gastroenterol. 34(2):282-5, 1999
                                          13. Schulman A: Ultrasound appearances of intra- and extrahepatic biliary ascariasis. Abdom Imaging. 23(1):60-6, 1998
                                          14. Barton P et al: Biliary sludge after liver transplantation: 1. Imaging findings and efficacy of various imaging procedures. AJR Am J Roentgenol. 164(4):859-64, 1995
                                          15. Khuroo MS et al: Sonographic findings in gallbladder ascariasis. J Clin Ultrasound. 20(9):587-91, 1992
                                          16. Zargar SA et al: Intrabiliary rupture of hepatic hydatid cyst: sonographic and cholangiographic appearances. Gastrointest Radiol. 17(1):41-5, 1992
                                          Related Anatomy
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                                          Related Differential Diagnoses
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                                          References
                                          Tables

                                          Tables

                                          KEY FACTS

                                          • Terminology

                                            • Imaging

                                              • Top Differential Diagnoses

                                                • Clinical Issues

                                                  • Diagnostic Checklist

                                                    TERMINOLOGY

                                                    • Synonyms

                                                      • Biliary sludge, tumefactive sludge, biliary sand, microlithiasis
                                                    • Definitions

                                                      • Presence of particulate material (calcium bilirubinate/phosphate or carbonate crystals with cholesterol monohydrate crystals) in bile
                                                        • Larger particles (1-3 mm) are microliths, which may become nidus for gallstones

                                                    IMAGING

                                                    • General Features

                                                      • Ultrasonographic Findings

                                                        • CT Findings

                                                          • MR Findings

                                                            • Nonvascular Interventions

                                                              • Imaging Recommendations

                                                                DIFFERENTIAL DIAGNOSIS

                                                                  PATHOLOGY

                                                                  • General Features

                                                                    • Gross Pathologic & Surgical Features

                                                                      CLINICAL ISSUES

                                                                      • Presentation

                                                                        • Demographics

                                                                          • Natural History & Prognosis

                                                                            • Treatment

                                                                              DIAGNOSTIC CHECKLIST

                                                                              • Consider

                                                                                • Image Interpretation Pearls

                                                                                  Selected References

                                                                                  1. Knab LM et al: Cholecystitis. Surg Clin North Am. 94(2):455-70, 2014
                                                                                  2. O'Connell K et al: Bile metabolism and lithogenesis. Surg Clin North Am. 94(2):361-75, 2014
                                                                                  3. Gore RM et al: Gallbladder imaging. Gastroenterol Clin North Am. 39(2):265-87, ix, 2010
                                                                                  4. Stinton LM et al: Epidemiology of gallstones. Gastroenterol Clin North Am. 39(2):157-69, vii, 2010
                                                                                  5. Venneman NG et al: Pathogenesis of gallstones. Gastroenterol Clin North Am. 39(2):171-83, vii, 2010
                                                                                  6. Smith EA et al: Cross-sectional imaging of acute and chronic gallbladder inflammatory disease. AJR Am J Roentgenol. 192(1):188-96, 2009
                                                                                  7. Pandya R et al: Hemorrhagic cholecystitis as a complication of anticoagulant therapy: role of CT in its diagnosis. Abdom Imaging. 33(6):652-3, 2008
                                                                                  8. Jüngst C et al: Gallstone disease: Microlithiasis and sludge. Best Pract Res Clin Gastroenterol. 20(6):1053-62, 2006
                                                                                  9. Choi D et al: Sonographic findings of active Clonorchis sinensis infection. J Clin Ultrasound. 32(1):17-23, 2004
                                                                                  10. Gremmels JM et al: Hemorrhagic cholecystitis simulating gallbladder carcinoma. J Ultrasound Med. 23(7):993-5, 2004
                                                                                  11. Green MH et al: Haemobilia. Br J Surg. 88(6):773-86, 2001
                                                                                  12. Nishiwaki M et al: Posttraumatic intra-gallbladder hemorrhage in a patient with liver cirrhosis. J Gastroenterol. 34(2):282-5, 1999
                                                                                  13. Schulman A: Ultrasound appearances of intra- and extrahepatic biliary ascariasis. Abdom Imaging. 23(1):60-6, 1998
                                                                                  14. Barton P et al: Biliary sludge after liver transplantation: 1. Imaging findings and efficacy of various imaging procedures. AJR Am J Roentgenol. 164(4):859-64, 1995
                                                                                  15. Khuroo MS et al: Sonographic findings in gallbladder ascariasis. J Clin Ultrasound. 20(9):587-91, 1992
                                                                                  16. Zargar SA et al: Intrabiliary rupture of hepatic hydatid cyst: sonographic and cholangiographic appearances. Gastrointest Radiol. 17(1):41-5, 1992