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LCH Choroid Plexus
Joseph Junewick, MD FACR
over 7 years ago
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Cholecystitis

Case Detail

Anatomy: Gastrointestinal
Junewick
Joseph Junewick, MD FACR
Diagnostic Category: Infectious-Inflammatory
Created: over 7 years ago
Updated: over 7 years ago
Tags: PEDS
Modality/Study Types: US
Activities:
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History

Teenager with right upper quadrant pain.


Case Images


Diagnosis

Cholecystitis

Findings

US – Gallbladder wall thickening and hyperemia.

Discussion

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.

Reference

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



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