Is a distended gallbladder measuring 5.7cm with a thin wall considered hydrops?

Gallbladder Hydrops: Diagnostic Criteria

A distended gallbladder measuring 5.7cm with a thin wall meets the definition of gallbladder hydrops, which is characterized by marked gallbladder distension without calculi, wall thickening, or acute inflammation. 1, 2

Defining Hydrops

Gallbladder hydrops is specifically defined as acute distension of the gallbladder without associated congenital anomalies, biliary calculi, or acute local inflammation. 2 The key diagnostic features that distinguish hydrops from acute cholecystitis include:

• Gallbladder size >5 cm in transverse diameter (your measurement of 5.7cm exceeds this threshold) 1
• Thin gallbladder wall (normal wall thickness is <3mm) 3, 1
• Absence of wall thickening (which would be ≥3-4mm and suggest inflammation) 3, 4
• Absence of pericholecystic fluid 1
• Absence of inflammatory signs (no Murphy's sign, fever, or systemic infection) 1

Critical Distinction from Acute Cholecystitis

Your case with a thin wall is the critical distinguishing feature. Acute cholecystitis requires gallbladder wall thickening >3mm, pericholecystic fluid, sonographic Murphy sign, and gallbladder distension—not just distension alone. 3, 1 Hydrops alone without inflammatory signs does not indicate acute cholecystitis. 1

The absence of wall thickening combined with a normal gallbladder wall has a 95% negative predictive value for acute cholecystitis. 1

Clinical Context Matters

Hydrops can occur in several clinical scenarios:

• Pediatric patients: Often associated with Kawasaki disease, scarlet fever, or other systemic illnesses 5, 2, 6
• Asymptomatic adults with gallstones: Requires expectant management in the absence of inflammatory signs 1
• Acalculous hydrops: May occur without stones, particularly in children 2

Management Implications

If this patient is asymptomatic, expectant management is recommended regardless of the hydrops, provided there are no signs of acute inflammation. 1 The effort and risks of surgical intervention outweigh the benefits in asymptomatic patients. 1

Immediate re-evaluation is warranted if the patient develops:

• Right upper quadrant pain or tenderness 1
• Fever or signs of systemic infection 1
• Murphy's sign on physical examination 1
• New laboratory abnormalities suggesting inflammation 1

Common Pitfall to Avoid

Do not confuse asymptomatic hydrops with acalculous cholecystitis, which occurs primarily in critically ill patients and presents with wall thickening, pericholecystic fluid, and clinical signs of infection—not just gallbladder distension with a thin wall. 1