RF: female sex, obesity, pregnancy, middle age, dm

• Stones: echogenic, mobile, posterior acoustic shadowing

• GB sludge: echogenic, mobile, non-shadowing.

• GB polyp: echogenic, nonmobile, nonshadowing, attached to GB wall via stalk

• Hyperplastic cholecystoses: echogenic, nonmobile, multiple polyps

• Porcelain GB: echogenic wall, shadowing.

• Adjacent bowel: echogenic wall, dirty shadowing. 

Helpful to reposition patient in left lateral decubitus position while scanning to assess whether the stones layer dependently to differentiate stones from polyp or other masses.

Inflammation of the GB due to an obstructing gallstone impacting the GB neck or cystic duct. Gallstones are seen >90% of time and a positive Murphy's sign also has a high PPV,

• GB wall thickening >3mm

• Distended GB >4 cm diameter

• Pericholecystic fluid or inflammatory changes

• Color Doppler showing hyperemic GB wall.

• Doppler associations:

  • Hepatic artery velocity >100 cm/sec

  • Cystic artery velocity >40 cm/sec

Look for complications:

• Gangrenous cholecystitis: asymmetric wall thickening, marked wall irregularities, intraluminal membranes.

• GB perforation: defect in GB wall with pericholecystic abscess or extraluminal stones.

• Emphysematous cholecystitis: Gas in GB wall/lumen

• Empyema of GB: highly reflective intraluminal echoes without shadowing purulent exudate/debris.

Solitary complex multiloculated cystic mass in liver w septations and mural calcifications.  May arise from intrahepatic BDs or less commonly the extrahepatic biliary tree or GB.

• Middle aged females

• Tumor is encapsulated and recurs if incomplete resection. 

• >30% risk of malignant degen even after years of stability; enhancing mural nodules suggests malignancy.

• Cyst fluid high in CA 19-9 though FNA is not recommended due to risk of dissemination. dx based mostly on imaging and resection w final pathology

• Microcystic variant resembles serous microcystic adenoma of pancreas.