Sludge in der Gallenblase
![](https://pacs.de/sites/default/files/pictures/thumbs/data.pacs.de/1/1/1/9/5/5/4b65212729e84b6ce21d8a439878b8_big_gallery_thumb.jpg)
![](https://pacs.de/sites/default/files/pictures/thumbs/data.pacs.de/1/1/1/9/5/6/9783b6f3c86bad3533526c25f1a593_big_gallery_thumb.jpg)
![](https://data.pacs.de/sites/default/files/mirrorimages/prod-images-static.radiopaedia.org/images/1911633/cd3bc9de09f75f3cc7d6570fa76776_big_gallery.jpg)
![](https://pacs.de/sites/default/files/pictures/thumbs/data.pacs.de/1/1/1/9/5/8/12daa1bea8c99f593afcf49acb3bfc_big_gallery_thumb.jpg)
![](https://pacs.de/sites/default/files/pictures/thumbs/data.pacs.de/1/1/1/9/6/0/34._big_gallery_thumb.jpg)
![](https://pacs.de/sites/default/files/pictures/thumbs/data.pacs.de/1/1/1/9/6/1/38e1f35e66fb6cbc86dc93ba31ed8c_big_gallery_thumb.jpg)
![](https://pacs.de/sites/default/files/pictures/thumbs/upload.wikimedia.org/1/2/6/6/7/5/Sludge_in_der_Gallenblase_80W_-_US_-_001_thumb.jpg)
Gallbladder sludge, also known as biliary sand, biliary sediment, or thick bile, is a mixture of particulate matter and bile, normally seen as a liquid-liquid level in the gallbladder on ultrasound, corresponding to the precipitate of bile solutes.
Terminology
The term biliary microlithiasis is occasionally used as a synonym for sludge, however this is not strictly correct. Microlithiasis refers to the tiny calculi (<3 mm) undetectable on normal transabdominal ultrasound. Sludge may include these microliths in its composition, but this is only one element of a variable mixture of crystals, proteinaceous debris, lysed cells and mucin .
Pathology
These precipitates consist of cholesterol monohydrate crystals, calcium bilirubinate granules, calcium salts, and mucus secreted by the gallbladder .
Radiographic features
Ultrasound
Gallbladder sludge appears as a low amplitude homogeneous echoes, layering on the posterior wall, and frequently forming fluid-fluid level with anechoic bile above it.
- it moves slowly with changes in patient position
- sludge does not cause shadowing unless associated with gallstones
Sludge can get compacted forming a mass-like lesion referred to as tumefactive sludge :
- hypoechogenic well defined intraluminal mass
- no posterior acoustic shadowing
- no internal vascularity at color Doppler
- mobility is not always demonstrated, therefore, raising differentials with polyps or gallbladder carcinoma
MRI
- T1: high-signal
- T2: iso- to mild hyperintensity
- T1 C+ (Gd): no enhancement
- DWI/ADC: no diffusion restriction
Complications
- biliary colic
- cholecystitis
- acute cholangitis
- pancreatitis
Siehe auch:
![Click für weniger anzeigen](/sites/all/modules/pacs/tools/imgs/collapse_up.png)
![](/sites/all/modules/pacs/tools/imgs/Iris_color_40.png)