Santos E Silva Ana, Sequeira Mafalda, Santos Maria Inês, Silva Luciana, Mariz José
Internal Medicine, Unidade Local de Saúde do Litoral Alentejano, Santiago do Cacém, PRT.
Serviço de Medicina Interna, Hospital Garcia de Orta, Almada, PRT.
Cureus. 2023 Feb 1;15(2):e34506. doi: 10.7759/cureus.34506. eCollection 2023 Feb.
Biliary sludge is an extremely viscous sediment, consisting essentially of calcium bilirubinate granules and cholesterol crystals, which, due to its high viscosity, has poor and slow movement, leading to a mass-like configuration called tumefactive biliary sludge. Tumefactive sludge was first described with the advent of ultrasonography in the 1970s and is an uncommon intraluminal lesion of the gallbladder (GB). The differential diagnoses for an echogenic mass in the GB lumen include GB carcinoma, tumefactive sludge, and gangrenous cholecystitis. Ultrasonography is the election method for the screening of GB diseases, with diagnostic accuracy exceeding 90%. The point-of-care ultrasound (POCUS) has shown a major improvement in the evaluation of hepatobiliary diseases. POCUS allows the detection of GB wall thickness, pericholestatic fluid, sonographic Murphy's sign, and dilatation of the common bile duct. The authors present a case of abdominal pain caused by the presence of tumefactive sludge in the GB, in which POCUS helped establish the diagnosis and therapeutic guidance.
胆泥是一种极具粘性的沉积物，主要由胆红素钙颗粒和胆固醇晶体组成，因其高粘性，移动性差且缓慢，导致形成一种类似肿块的形态，称为肿胀性胆泥。肿胀性胆泥最早在20世纪70年代随着超声检查的出现而被描述，是胆囊（GB）一种罕见的腔内病变。胆囊腔内强回声团块的鉴别诊断包括胆囊癌、肿胀性胆泥和坏疽性胆囊炎。超声检查是筛查胆囊疾病的首选方法，诊断准确率超过90%。床旁超声（POCUS）在肝胆疾病评估方面有了重大改进。POCUS可检测胆囊壁厚度、胆汁淤积周围液体、超声墨菲氏征以及胆总管扩张。作者报告了一例因胆囊内存在肿胀性胆泥而引起腹痛的病例，其中POCUS有助于确立诊断并提供治疗指导。
