0:00

All right, now we are going to look at case two. Case two and two B.

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They go parallel to each other.

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Case two A is a 14 day old male with some congenital heart disease

0:13

and we are asked to look for congenital anomalies in the belly.

0:16

And we are going to perform the ultrasound case.

0:20

Two B is a one day old with antenatal diagnosis of gallstones.

0:25

So let's look at the first one

0:29

and you can look at the ultrasound images of the right upper upper quadrant.

0:34

This is the liver, this is the gallbladder

0:40

that's the right kidney. You

0:46

don't see any intra or extra hepatic bi ductal dilatation.

0:51

That's the aota, that's the bladder,

0:55

that's the right kidney. So with congenital heart disease,

1:00

you the most common anomaly is the renal anomaly, left kidney.

1:04

So we have ruled the genital urinary anomaly here. Have a,

1:10

when we look at the gallbladder, that does not look normal.

1:15

Now let's look at the second case, two B.

1:20

This is a brand new baby just born today. That's the liver,

1:26

that's the pancreas.

1:30

That's the common bile duct. That's the port rain.

1:35

And here is the gallbladder.

1:36

You see something hyper coic and some shadowing there.

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As you can see,

1:47

most of these hyper coic lesions are adherent to the gallbladder wall.

1:55

That's the left kidney, that's the right kidney. And the spleen.

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On Doppler examination, there was no, um,

2:05

abnormal doppler signal on either cases.

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So now let's go back to our question.

2:16

So in both the cases, you have to pick one of these options.

2:19

So can we do the poll please?

2:23

So we have cholelithiasis,

2:25

adenomyosis normal examination or gall bladder neoplasm.

2:30

Out of these four, you have to select one,

2:34

and I hope there is another call for the second two B.

2:39

So for first case it is probably sis.

2:43

And what about the second case two B. Alright,

2:47

so the first case, um, as someone answered correctly, uh,

2:52

was newborn.

2:55

There were tiny stones in the gall bladder because the baby does not have

2:59

enough time yet to form larger stones.

3:02

The gallstones presenters very tiny stones in the gall bladder with

3:07

or without shadowing. If the gallstones are less than three millimeters,

3:11

there is no significant shadowing. In fact,

3:13

there is hyper posterior to these tiny stones who

3:18

gets, which newborn babies can get gallbladder stones.

3:21

Gallbladder stones can be seen in patients who have been on t p n diuretics,

3:26

fellow sprains, uh, premature babies can get gallstones. Uh,

3:30

gallstones are also associated with congenital heart disease,

3:33

hemolytic conditions, both maternal as well as fetal,

3:38

I mean, uh, in the newborn babies.

3:41

And if there is any disruption of hepatic circulation, for example,

3:45

there is animal pulmonary venous, uh,

3:48

returned to the hepatic vasculature or, uh, there is bud Chiari.

3:53

Um, spontaneous resolution of gallstones is a known phenomenon.

3:58

It can re, the gallstones can resolve within a year. However,

4:02

if the medical treatment is required there, that is available.

4:05

If the gallstones become larger in size and they get impacted,

4:09

then they have to be removed by endoscopic retrograde angiography or

4:13

percutaneous drainage of the gallstone ga may be required. As I said earlier,

4:18

if the gallstones are very tiny and if they're less than three millimeters in

4:22

size,

4:22

they may not shadow at all versus gall bladder adenomyosis in

4:27

a new newborn baby, um, as we saw in the second case,

4:31

those hyper coic areas were stuck to the gallbladder wall.

4:36

They did not move. That is the key feature.

4:40

The mucosa insinuates into the muscle and those

4:45

sinuses are formed, which are called as kinski esco sinuses.

4:50

The key feature here is hypertrophy of the gall better wall as well as the

4:55

mucosal epithelium. There are different types.

4:57

We definitely don't see all of them. Commonly we see generalized variety. Um,

5:02

annual and localized and segmental have a very different appearance and they're

5:06

extremely foho. Um,

5:09

most of the times gallbladder radio myosis, um,

5:13

it's asymptomatic and the complication per se is stone formation.

5:17

So you can get confused between idino, myosis and stone formation.

5:22

Now why do we not, why do we need to distinguish between them? Um,

5:27

the first and foremost is gallad.

5:30

Adenomas is associated with gallad or cancer in later part of the life.

5:36

Um, if there is any chance that this may lead to the formation of gallstones,

5:40

that can lead to, um, colitis cystitis as well as gallad perforation.

5:45

Those are the other potential complications.

5:48

So gallbladder ran osis, although it's very rare in the one infant,

5:52

is an important entity to keep in mi in mind when you see these tiny hyper

5:56

echoic, uh, lesions in the gallbladder wall with no shadowing.