imaging of acute cholecystitis · cholecystite . acute non complicated ch - edematous form...

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1 Voies biliaires Techniques Vésicule biliaire – Lithiase – Inflammation Tumeurs et pseudo- tumeurs Voies biliaires Lithiase Anomalies congénitales Inflammation Tumeurs

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Page 1: Imaging of Acute Cholecystitis · CHOLECYSTITE . Acute non complicated ch - Edematous form Complicated form ch - Necrosing - Suppurative - Emhysematous Chronic - Chronic - Xanthogranulomatous

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Voies biliaires • Techniques

• Vésicule biliaire – Lithiase – Inflammation – Tumeurs et pseudo-

tumeurs • Voies biliaires

– Lithiase – Anomalies congénitales – Inflammation – Tumeurs

Page 2: Imaging of Acute Cholecystitis · CHOLECYSTITE . Acute non complicated ch - Edematous form Complicated form ch - Necrosing - Suppurative - Emhysematous Chronic - Chronic - Xanthogranulomatous

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Vésicule biliaire : lithiase

• US • CT • IRM

Page 3: Imaging of Acute Cholecystitis · CHOLECYSTITE . Acute non complicated ch - Edematous form Complicated form ch - Necrosing - Suppurative - Emhysematous Chronic - Chronic - Xanthogranulomatous

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Page 4: Imaging of Acute Cholecystitis · CHOLECYSTITE . Acute non complicated ch - Edematous form Complicated form ch - Necrosing - Suppurative - Emhysematous Chronic - Chronic - Xanthogranulomatous

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US TDM IRM

Page 5: Imaging of Acute Cholecystitis · CHOLECYSTITE . Acute non complicated ch - Edematous form Complicated form ch - Necrosing - Suppurative - Emhysematous Chronic - Chronic - Xanthogranulomatous

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Vésicule biliaire : cholécystite

• US • CT • IRM

CHOLECYSTITE

Page 6: Imaging of Acute Cholecystitis · CHOLECYSTITE . Acute non complicated ch - Edematous form Complicated form ch - Necrosing - Suppurative - Emhysematous Chronic - Chronic - Xanthogranulomatous

Acute non complicated ch - Edematous form Complicated form ch - Necrosing - Suppurative - Emhysematous Chronic - Chronic - Xanthogranulomatous f

Page 7: Imaging of Acute Cholecystitis · CHOLECYSTITE . Acute non complicated ch - Edematous form Complicated form ch - Necrosing - Suppurative - Emhysematous Chronic - Chronic - Xanthogranulomatous

Scope of the Disease Prevalence = 5 %

145 to 153 in 2013 at St-Luc University Hospital

900 beds

> 50.000 emergency visits/ year

Page 8: Imaging of Acute Cholecystitis · CHOLECYSTITE . Acute non complicated ch - Edematous form Complicated form ch - Necrosing - Suppurative - Emhysematous Chronic - Chronic - Xanthogranulomatous
Page 9: Imaging of Acute Cholecystitis · CHOLECYSTITE . Acute non complicated ch - Edematous form Complicated form ch - Necrosing - Suppurative - Emhysematous Chronic - Chronic - Xanthogranulomatous

Cholécystite Aiguë

US : - Signe de Murphy

- Majoration du diamètre transverse > 4 cm

- Calcul ou de sludge

- Paroi de la vésicule > 5 mm

- Uquide périvésiculaire

Page 10: Imaging of Acute Cholecystitis · CHOLECYSTITE . Acute non complicated ch - Edematous form Complicated form ch - Necrosing - Suppurative - Emhysematous Chronic - Chronic - Xanthogranulomatous

Cholécystite Aiguë

Page 11: Imaging of Acute Cholecystitis · CHOLECYSTITE . Acute non complicated ch - Edematous form Complicated form ch - Necrosing - Suppurative - Emhysematous Chronic - Chronic - Xanthogranulomatous
Page 12: Imaging of Acute Cholecystitis · CHOLECYSTITE . Acute non complicated ch - Edematous form Complicated form ch - Necrosing - Suppurative - Emhysematous Chronic - Chronic - Xanthogranulomatous

Cholécystite Gangréneuse - Forme Sévère de cholécystite = > Altérations

Ischémiques / nécrotiques - Incidence : 2 à 30 % - 10 à 40 % de cholécystites classiques se

compliquent - âgés, hommes, Diabète

Nikfarjam et al, HPB 2011, 13, 551–558

Page 13: Imaging of Acute Cholecystitis · CHOLECYSTITE . Acute non complicated ch - Edematous form Complicated form ch - Necrosing - Suppurative - Emhysematous Chronic - Chronic - Xanthogranulomatous

Apport de l’US

Page 14: Imaging of Acute Cholecystitis · CHOLECYSTITE . Acute non complicated ch - Edematous form Complicated form ch - Necrosing - Suppurative - Emhysematous Chronic - Chronic - Xanthogranulomatous

Cholécystite simple Cholécystite gangréneuse

Page 15: Imaging of Acute Cholecystitis · CHOLECYSTITE . Acute non complicated ch - Edematous form Complicated form ch - Necrosing - Suppurative - Emhysematous Chronic - Chronic - Xanthogranulomatous

Cholécystite Gangréneuse

- hémorragie :

= > intraluminale

=> péritonéale

- perforation:

=> Dans le péritoine : péritonite biliaire aigue(10%)

= > forme focale « couverte» : (subaiguë) abcès périvésiculaire (60%)

= > fistule bilio-enterique : iléus biliaire (30%)

Page 16: Imaging of Acute Cholecystitis · CHOLECYSTITE . Acute non complicated ch - Edematous form Complicated form ch - Necrosing - Suppurative - Emhysematous Chronic - Chronic - Xanthogranulomatous
Page 17: Imaging of Acute Cholecystitis · CHOLECYSTITE . Acute non complicated ch - Edematous form Complicated form ch - Necrosing - Suppurative - Emhysematous Chronic - Chronic - Xanthogranulomatous

DD Cholécystite Emphysémateuse

Page 18: Imaging of Acute Cholecystitis · CHOLECYSTITE . Acute non complicated ch - Edematous form Complicated form ch - Necrosing - Suppurative - Emhysematous Chronic - Chronic - Xanthogranulomatous

Cirrhose Hépatite Insuffisance Cardiaque

Page 19: Imaging of Acute Cholecystitis · CHOLECYSTITE . Acute non complicated ch - Edematous form Complicated form ch - Necrosing - Suppurative - Emhysematous Chronic - Chronic - Xanthogranulomatous

NEOPLASIE

Page 20: Imaging of Acute Cholecystitis · CHOLECYSTITE . Acute non complicated ch - Edematous form Complicated form ch - Necrosing - Suppurative - Emhysematous Chronic - Chronic - Xanthogranulomatous

CT diagnosis

APPORT DU CT

Page 21: Imaging of Acute Cholecystitis · CHOLECYSTITE . Acute non complicated ch - Edematous form Complicated form ch - Necrosing - Suppurative - Emhysematous Chronic - Chronic - Xanthogranulomatous
Page 22: Imaging of Acute Cholecystitis · CHOLECYSTITE . Acute non complicated ch - Edematous form Complicated form ch - Necrosing - Suppurative - Emhysematous Chronic - Chronic - Xanthogranulomatous

Gangrenous Cholecystitis & CT

ELEMENTS CLES = > paroi irrégulière = > défaut de prise de contraste = > épaisseur de la paroi = > petit axe de la vésicule

Page 23: Imaging of Acute Cholecystitis · CHOLECYSTITE . Acute non complicated ch - Edematous form Complicated form ch - Necrosing - Suppurative - Emhysematous Chronic - Chronic - Xanthogranulomatous

MRI

Page 24: Imaging of Acute Cholecystitis · CHOLECYSTITE . Acute non complicated ch - Edematous form Complicated form ch - Necrosing - Suppurative - Emhysematous Chronic - Chronic - Xanthogranulomatous

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Lithiase des voies biliaires

• Elle provient souvent de la migration d’un calcul vésiculaire

• Elle peut également se former dans les voies biliaires en étant favorisée par la stase et l’infection

• Elle peut provoquer un obstacle (ictère, angiocholite) ou une pancréatite aiguë

Page 25: Imaging of Acute Cholecystitis · CHOLECYSTITE . Acute non complicated ch - Edematous form Complicated form ch - Necrosing - Suppurative - Emhysematous Chronic - Chronic - Xanthogranulomatous

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Imagerie de la lithiase des voies biliaires

• Echographie : sensibilité faible • CholangioIRM : sensibilité élevée • Echoendoscopie : lithiase du cholédoque

Page 26: Imaging of Acute Cholecystitis · CHOLECYSTITE . Acute non complicated ch - Edematous form Complicated form ch - Necrosing - Suppurative - Emhysematous Chronic - Chronic - Xanthogranulomatous

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Page 27: Imaging of Acute Cholecystitis · CHOLECYSTITE . Acute non complicated ch - Edematous form Complicated form ch - Necrosing - Suppurative - Emhysematous Chronic - Chronic - Xanthogranulomatous

Lithiase de la voie biliaire principale

Cas normal

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Page 28: Imaging of Acute Cholecystitis · CHOLECYSTITE . Acute non complicated ch - Edematous form Complicated form ch - Necrosing - Suppurative - Emhysematous Chronic - Chronic - Xanthogranulomatous

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Vésicule biliaire : tumeurs et pseudotumeurs

• Granulome à cholestérine (< 6 mm) – Unique – Multiples (cholestérolose, vésicule fraise)

• Adénomyose – Hyperplasie de la muqueuse et de la musculeuse

• Epaississement pariétal (localisé, diffus) • Artéfacts en queue de comète

• Tumeur – Polype (> 6 mm) – Adénocarcinome

• Polype > 10 mm ou épaississement pariétal focal • Si découverte tardive : masse envahissant foie et voies biliaires

Page 29: Imaging of Acute Cholecystitis · CHOLECYSTITE . Acute non complicated ch - Edematous form Complicated form ch - Necrosing - Suppurative - Emhysematous Chronic - Chronic - Xanthogranulomatous

Granulomes et polypes 29

Page 30: Imaging of Acute Cholecystitis · CHOLECYSTITE . Acute non complicated ch - Edematous form Complicated form ch - Necrosing - Suppurative - Emhysematous Chronic - Chronic - Xanthogranulomatous
Page 31: Imaging of Acute Cholecystitis · CHOLECYSTITE . Acute non complicated ch - Edematous form Complicated form ch - Necrosing - Suppurative - Emhysematous Chronic - Chronic - Xanthogranulomatous

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Page 32: Imaging of Acute Cholecystitis · CHOLECYSTITE . Acute non complicated ch - Edematous form Complicated form ch - Necrosing - Suppurative - Emhysematous Chronic - Chronic - Xanthogranulomatous

Adenomyomatosis Prevalence: 3-5% (W/M: 3/1) Mecanism: wall hyperplasia Wall: > 10mm (diffuse ou focal) Etiology: ? Asymptomatic. No R/

Page 33: Imaging of Acute Cholecystitis · CHOLECYSTITE . Acute non complicated ch - Edematous form Complicated form ch - Necrosing - Suppurative - Emhysematous Chronic - Chronic - Xanthogranulomatous
Page 34: Imaging of Acute Cholecystitis · CHOLECYSTITE . Acute non complicated ch - Edematous form Complicated form ch - Necrosing - Suppurative - Emhysematous Chronic - Chronic - Xanthogranulomatous
Page 35: Imaging of Acute Cholecystitis · CHOLECYSTITE . Acute non complicated ch - Edematous form Complicated form ch - Necrosing - Suppurative - Emhysematous Chronic - Chronic - Xanthogranulomatous