Gallbladder Mucocele Workup
- Author: R Vijayaraghavan, MBBS, MS, FRCS(Edin); Chief Editor: John Geibel, MD, DSc, MSc, MA more...
No single laboratory test is diagnostic of a mucocele. However, laboratory workup should include all tests performed for acute cholecystitis. Typical findings include the following:
A mild leukocytosis with a shift to the left is common; higher counts indicate the possibility of acute cholecystitis or infected bile
Bilirubin levels are usually within the reference range; they may be mildly raised in patients with Mirizzi syndrome or those with associated common bile duct (CBD) obstruction or cholangitis
Liver enzymes are usually within the reference range, though a mild rise in alkaline phosphatase may be present; any large increase should raise the suspicion of an obstructed CBD
Serum amylase levels are generally within the reference range; any large increase suggests the possibility of acute pancreatitis due to an obstruction close to the ampulla of Vater [1, 2, 3]
Ultrasonography, though entirely operator-dependent, is extremely sensitive in detecting stones in the gallbladder. A grossly distended, thin-walled gallbladder measuring more than 5 cm across anteroposteriorly, an impacted stone in the infundibulum or neck of the gallbladder or in the cystic duct, and clear fluid content indicate a possible mucocele (see the images below). The ultrasonographic Murphy sign may be positive.
The wall may be thickened, and a small amount of pericholecystic fluid may be present in patients with acute cholecystitis (see the first and second images below). Gross wall thickening and murky, thick fluid with sediments and a pericholecystic collection suggest an empyema or pyocele of the gallbladder (see the third image below). Ultrasonography is also useful in identifying ductal obstruction and is extremely sensitive in identifying intrahepatic biliary tree dilatation.[1, 3, 6]
Other Imaging Studies
Plain radiography of the abdomen may show a soft-tissue–density shadow with an intraluminal calcific shadow in the subhepatic region. By itself, this finding is nonspecific; it should be used only as a guideline in the differential diagnosis.
Scintigraphy (hepato-iminodiacetic acid [HIDA] scanning) may be indicated in obscure cases, though it can offer only indirect evidence. Nonvisualization of the gallbladder indicates an obstructed gallbladder and possible acute cholecystitis; nonvisualization in the small intestine indicates CBD obstruction.
Computed tomography (CT) may be indicated in cases where the diagnosis is unclear or where there are other associated conditions or complications that must be assessed. The gallbladder is well visualized on CT scanning, and the wall and contents are readily assessed; however, stones may be difficult to identify. The best use of CT may lie in the evaluation of associated hepatic conditions, pancreatitis, and complications such as abscess formation or perforation of the gallbladder.
Magnetic resonance cholangiopancreatography (MRCP) clearly shows the biliary-pancreatic tree, and it is increasingly being used in place of diagnostic endoscopic retrograde cholangiopancreatography (ERCP) to assess the biliary tree. Cholecystokinin (CCK)-enhanced studies are more specific.
Occasionally, percutaneous injection of contrast into the mass may be carried out to identify anatomic details.
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