DDx
Diagnostic Considerations
The diagnosis of a mucocele should be considered in the following instances:
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Minimal acute inflammatory signs are present
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A large, palpable, minimally tender gallbladder is found on clinical examination
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Laboratory test results are normal or just within the upper limit of reference range values
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Plain radiography of the abdomen shows a soft-tissue–density globular shadow in the subhepatic region
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Ultrasonography of the right upper quadrant (RUQ) shows evidence of minimal wall thickening, an impacted stone in the neck, or infundibulum of an enlarged gallbladder and clear content
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Intraoperatively, the aspirate from the gallbladder is clear and watery or mucoid (white bile)
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Upon being opened, the gallbladder shows a white wall, clear and watery or mucoid content, a stone or stones impacted in the neck or cystic duct, a narrowed cystic duct, or a tumor or polyp causing obstruction of the neck of the gallbladder
Other problems to be considered in making the diagnosis include the following:
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Hepatomegaly, choledochal cyst
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Courvoisier gallbladder due to simultaneous obstruction of the gallbladder and common bile duct
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Pseudocyst of the pancreas
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Renal mass
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Right suprarenal gland mass
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Mesenteric cysts
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Parasitic cysts - Hydatid cyst
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Ascending colon mass
Media Gallery
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Image is from a 35-year-old woman who presented with recurrent episodes of right upper quadrant colic; most recent attack was 3 days before. Gross wall thickening is apparent; this is usually measured on anterior wall of gallbladder. Also apparent are clear content, stone in neck of gallbladder, and absence of pericholecystic fluid. All favor diagnosis of acute cholecystitis.
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Stone in neck of gallbladder, with postacoustic shadowing. Minimal wall thickening and dilated gallbladder suggest mucocele.
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Transverse scan shows stone in neck of gallbladder, with postacoustic shadowing. Minimal wall thickening and dilated gallbladder are also visible.
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Transverse scans show layering of gallbladder wall; this suggests edema and indicates acute cholecystitis.
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Longitudinal scan shows layering, with fluid in wall of gallbladder and impacted stone in neck of gallbladder. Intraluminal shadowing indicates sediments in fluid; image indicates acute cholecystitis with possible pyocele of gallbladder.
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Cluster of impacted calculi in neck of gallbladder, minimal wall thickening, and clear content; this indicates mucocele of gallbladder.
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Cluster of calculi with postacoustic shadowing in neck of gallbladder, normal wall, and clear content; this indicates mucocele of gallbladder.
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Distended gallbladder with evidence of adhesions on its wall. Irregular surface indicates recurrent attacks of cholecystitis.
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Yellowish aspirate from gallbladder of a 28-year-old woman who presented with features of right upper quadrant peritonitis. Slightly yellowish fluid was sterile and was rich in cholesterol.
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Subserosal perforation of acute, emphysematous, acalculous cholecystitis in a 58-year-old diabetic man. Patient presented with features suggestive of ileus. He had high intrathoracic liver (and gallbladder), and clinical signs were atypical. Green color is unusual.
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Laparoscopic view of distended gallbladder in woman aged 70 years with sudden onset of severe right upper abdominal pain.
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Stone being extracted from cystic duct through small ductotomy.
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