Peri-cholecystic hyper-echogenicities in necrotizing enterocolitis: a specific sonographic sign?

The authors report a new sonographic pattern found in association with neonatal necrotizing enterocolitis in 5 newborns: hyperechogenicities around the gallbladder. The pattern probably corresponds to extension of the disease to the perivesicular space. The most probable hypothesis for that extension is diffusion by contiguity through the lesser sac and/or the right gutter. The hyperechogenicities could be related to the foamy infiltrate typical of NEC. Air within the pericholecystic vascular system similar to portal air could be another (less probable) explanation.