Goubaa Mohamed MD Djerba Tunisia

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This is a 29-year-old male with vague right upper quadrant abdominal pain, exacerbated by fatty food ingestion. Physical examination and laboratory tests were unremarkable. What is your diagnosis based on the ultrasound scans C'est un patient de 29 ans se présentant pour des douleurs abdominales vagues de l'hypochondre droit, aggravée par l'ingestion d'aliment gras. L'examen physiques et les analyses biologiques étaient sans anomalies. Quel est votre diagnostic en se basant sur ces images échographiques?

Case 1
Cas 1








Case 2
Cas 2


Case 3
Cas 3

Click on the image below
Cliquez sur les images en bas



The ultrasound examination detected hypoechoic polypoid structure (case 1) projecting into the gallbladder lumen. No posterior shadowing is evident. this foci do not have the other characteristic of gallstone, i.e., positioning in the most dependent portion of the gallbladder and distal acoustic shadowing (case 2 : small stone without shadowing ).
Color Doppler view shows the vascular pedicle of a polyp, which helps to distinguish this from tumefactive sludge (case 3 ).
L'échographie a détecté une structure polypoide hypoéchogène (cas 1) se projetant dans la lumière de la vésicule biliaire. Aucun cône d'ombre postérieur n'est visible et ce polype n'a pas n'a pas les autres caractéristiques du calcul biliaire, c.-à-d., mobile se plaçant dans différents endroits de la vésicule et générant un cône d'ombre postérieur (cas 2 : calcul mais sans cône d'ombre car petit).
L'examen au Doppler couleur montre le pédicule vasculaire d'un polype, qui aide à distinguer celui-ci de la boue biliaire (cas 3).





Small polyp in the gallbladder lumen
Petit polype de la vésicule biliaire


Gallbladder Polyp

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Gallbladder polyps are usually asymptomatic lesions which are incidental findings in up to 5% of the population. The most common type are cholesterol polyps. Cholesterol polyps account for approximately 50% of all polypoid lesions of the gallbladder.
Cholesterol polyps are generally asymptomatic. Occasionally they are the cause of biliary colic.
Cholesterol polyps are usually 5 mm or less and only rarely get bigger than 10 mm.
Other types of gallbladder polyps occur but are less common than cholesterol polyps. These include adenomas, papillomas, leiomyomas, lipomas, and neuromas. These lesions are true neoplasms and are almost always solitary and are usually larger than cholesterol polyps.

Ultrasonography is the most effective diagnostic method for detecting the polypoid lesion of the gallbladder.
The most common type are cholesterol polyps. These are reflective structures which project into the gallbladder lumen but do not cast an acoustic shadow. Unless on a long stalk they will remain fixed on turning the patient and are therefore distinguishable from stones.
They are attached to the wall by means of a slender stalk. The stalk is rarely seen so they typically appear as a mass that is adjacent to the wall but barely attached to the wall : this is referred to as the "ball on the wall" sign. There are usually multiple polyps, although it is not uncommon to detect only the largest one sonographically
They can be distinguished from gallbladder stones by their lack of a shadow and nonmobile nature and from sludge balls by their lack of mobility. Their small size and multiplicity help to distinguish them from true neoplasms of the gallbladder wall.
Supplementary US examination in the harmonic mode is advantageous : the polyps were more evident on harmonic images and The number of polyps revealed in US examination is larger in the harmonic mode..
Larger polyps may have detectable blood flow on color Doppler imaging

* Small adherent gallstones,
* Neurofibroma
* Papillomas
* Carcinoma.
* Metastatic disease to the gallbladder is very uncommon but can produce multiple polypoid lesions. Melanoma has the greatest tendency to spread to the gallbladder, and detection of gallbladder polyps should be viewed with a high level of suspicion in patients with a history of melanoma. Generally there will be other evidence of metastatic disease in the liver, lymph nodes, or elsewhere in the abdomen.

Regarding gallbladder polyps, the risk for malignancy is increased when the lesion is greater than 1 cm especially in patients over 50 years of age. The current recommendations for resection of gallbladder polyps include any lesion that is enlarging, symptomatic, or greater than 1 cm. The recommendations for lesions less than 1 cm include follow-up and reevaluation of the lesion via repeat imaging studies.

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