From the Guidelines
Ultrasound is the imaging modality of choice for evaluating a deflated gallbladder. When a patient presents with symptoms suggesting gallbladder pathology and a deflated gallbladder is suspected, an abdominal ultrasound should be performed first due to its high sensitivity for gallbladder abnormalities, lack of radiation, wide availability, and cost-effectiveness 1. The examination should be conducted after the patient has fasted for at least 6 hours to allow for optimal gallbladder distension.
Key Considerations
- If the gallbladder appears contracted or collapsed despite fasting, this may indicate underlying pathology such as chronic cholecystitis, fibrosis, or adenomyomatosis.
- In cases where ultrasound findings are inconclusive, magnetic resonance cholangiopancreatography (MRCP) would be the next best imaging option as it provides detailed evaluation of the biliary system without radiation exposure.
- Contrast-enhanced CT may be considered if complications such as perforation or abscess are suspected, as suggested by the American College of Radiology 1.
Rationale
The deflated appearance on imaging is significant because a normally functioning gallbladder should distend after fasting, and failure to do so often indicates underlying disease processes affecting gallbladder contractility or wall compliance.
Imaging Modalities
- Ultrasound is preferred due to its high sensitivity, lack of radiation, and cost-effectiveness 1.
- MRCP is a suitable alternative when ultrasound findings are inconclusive, providing detailed evaluation of the biliary system without radiation exposure.
- Contrast-enhanced CT may be considered for suspected complications, but its use should be weighed against the risks of radiation exposure 1.
From the Research
Deflated Gallbladder Imaging
The imaging modality of choice for a deflated gallbladder is:
- Ultrasound, due to its ease of accessibility, low cost, lack of ionizing radiation, and excellent spatial resolution 2, 3, 4, 5, 6
Advantages of Ultrasound
The advantages of using ultrasound for gallbladder imaging include:
- Wide availability
- Speed
- Superior spatial resolution
- Ability to detect gallstones and other pathologies 3, 4, 6
Role of Other Imaging Modalities
Other imaging modalities, such as computed tomography (CT) and magnetic resonance imaging (MRI), may be used:
- In cases of ambiguous findings or potential complications
- To evaluate patients with suspected cholestatic presentation
- To detect choledocholithiasis 3, 4, 5, 6
Specific Imaging Findings
Specific imaging findings for gallbladder pathologies, such as gallstones, adenomyomatosis, and acute cholecystitis, can be detected using: