Gall stones

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(aka Cholelithiasis)

Stones are mixtures of cholesterol, calcium bilirubinate and calcium carbonate. Cholesterol stones make up 75% and pigmented stones the remainder (25% not visualized on CT) [1]. Stones appear similar on US.

Differential Diagnosis

  • Polyp - do not move or shadow
  • Sludge - mobile collection of crystals, does not shadow
  • Shadowing Bowel Gas - can differential with (WES)
  • Cholangiocarcinoma
  • Wall Fold
  • Emphasematous Cholecystitis - from gas forming bacteria, echo in non-dependant portion of GB and ring down effect.
  • Cholesterolosis - cholesterol deposits in tissue
  • Adenomyomatosis - benign tumor

Wall Echo Shadow (WES)

Differeciates shadowing bowel gas and cholelithiasis.

Gall stones have three distinct lines:

  • Echogenic Line - pericholecystic fat
  • Hypoechoic Line - GB wall
  • Echogenic Line - stone

See Also



  1. CT Evaluation of Gallstones in Vitro