Hosting 728 files, 2951 images, and 4 contributors.

Random Case

Neuroblastoma - Stage 4S
Joseph Junewick, MD FACR
over 8 years ago
Enter A Workflow
Standard2   Academic2

Please choose a workflow. A standard workflow allows you to browse the repository with full case detail; the academic workflow allows you to browse the repository with limited case detail revealed. Double click on the images to launch image viewer.

ARSt Case Repository


Case Detail

Anatomy: Gastrointestinal
Joseph Junewick, MD FACR
Diagnostic Category: Infectious-Inflammatory
Created: over 10 years ago
Updated: over 10 years ago
Tags: PEDS
Modality/Study Types: US
Adobe32 PDF Imagej32 ImageJA


Teenager with right upper quadrant pain.

Case Images




US – Gallbladder wall thickening and hyperemia.


Cholecystitis in children is unusual. Cholecystitis may be calculous or acalculous although it is more often acalculous in pediatric patients. Gallstones in children may be related to hemolytic anemias (sickle cell disease, spherocytosis, thalassemia, Wilson’s disease), cystic fibrosis, total parenteral nutrition, congenital abnormalities (Carolli’s disease, choledochocele), medications (furosemide, cephtriaxone), or neonatal disease (prematurity, sepsis).

Normal gallbladder mucosa is absorptive. Bile stasis leads to accumulation of phospholipase. Phospholipase promotes hydrolysis of lecithin to prostaglandins E2. Prostaglandins E2 converts the gallbladder mucosa to secretory. Distention of the gallbladder leads to impaired perfusion and ischemic necrosis. Infection does not likely contribute to cholecystitis.

Cholecystitis can be diagnosed on sonography by gallbladder distention, mural thickening and hyperemia, pericholecystic fluid and tenderness. Stones may or may not be present. Mural thickening is the most predictive sign.


Greenberg M, Kangarloo H, Cochran ST, Sample WF. The ultrasonographic diagnosis of cholecystitis and cholelithiasis in children. Radiology (1980; 137:745-749.

Corporate Office: 616.363.7272, 3264 North Evergreen Drive, Grand Rapids, MI 49525

Spectrum Health Helen Devos Childrens Hospital GE HealthCare