Strong acoustical shadowing from the gallbladder bed: ultrasonic-pathologic correlation

We reviewed a series of 25 patients whose cholecystosonograms showed ultrasonic nonvisualization of the gallbladder, high-amplitude echoes in the region of the gallbladder bed, and strong acoustical shadowing. These 3 findings have previously been thought to be a reliable indication of a small contracted gallbladder filled with stones. In our series, all 25 such patients did not have gallstones, but the size and number of the calculi were highly variable. Only a small minority of our patients had a contracted gallbladder in most, the volume of the gallbladder was either normal or greater than normal. Ultrasonic nonvisualization of the gallbladder accompanied by acoustical shadowing was not a reliable indicator of gallbladder wall thickness in our series. Of 25 patients, 20 had either a normal gallbladder wall or only slight thickening. When we reviewed our images to determine how many fit the "WES" criteria thought to be a specific manifestation of a contracted gallbladder filled with stones, we found that 14 of 25 individuals clearly showed this group of ultrasonic findings. We could not, however, correlate the presence or absence of the 'WES' triad with the number and size of stones, the gallbladder volume, or thickness of the gallbladder wall.