Pediatric Cholelithiasis

  • Etiology in neonates: Cholestasis due to infection or metabolic disorders or genetic disorders, diuretics, idiopathic
  • Etiology beyond neonates: Hemolysis (due to sickle cell disease, thalassemia, hereditary spherocytosis), cystic fibrosis, inflammatory bowel disease, obesity
  • Imaging AXR: ~ 25% are radiopaque
  • Imaging US: Mobile echogenic object with posterior shadowing
  • Note: US only mildly sensitive for detection of choledocholithiasis
  • Imaging CT: ~ 100% are radiodense
  • DDX:
  • Complications: Gallstone pancreatitis with presence of gallstone in distal common bile duct causing pancreatic duct obstruction and elevated pancreatic enzymes
  • Treatment:
  • Clinical: Mirrizi syndrome is common hepatic duct obstruction caused by extrinsic compression from impacted stone in cystic duct or infundibulum of gallbladder

Radiology Cases of Cholelithiasis

AXR and CT of cholelithiasis due to sickle cell disease
AXR AP (left) shows faint calcifications in the right upper quadrant, just beneath the tip of the 12th rib and at the level of the L2 vertebral body which are better demonstrated on the coronal CT without contrast of the abdomen which demonstrates 5 calcifications within the gallbladder.
MR of gallstone
Coronal HASTE (above) and axial T2 (below) MRI without contrast of the abdomen shows the gallbladder to contain over 20 small, round low-signal intensity objects. The gallbladder wall is not thickened.
US of gallstones in sickle cell disease
Sagittal (above) and transverse (below) US of the gallbladder show multiple small round echogenic mobile objects within the gallbladder that cause posterior shadowing.

Radiology Cases of Cholelithiasis Causing Acute Cholecystitis

US of pediatric acute cholecystitis due to gall stone in the cystic duct
Sagittal US of the gallbladder (above) shows the gallbladder wall is thickened. The gallbladder is filled with sludge and there is a cresenteric echogenic object within the lumen of the gallbladder that has posterior shadowing. Sagittal US of the gallbladder neck (below) shows the gallbladder is filled with sludge and there is a cresenteric echogenic object within the neck of the gallbladder that has posterior shadowing.

Radiology Cases of Choledocholithiasis Causing Gangrenous Cholecystitis

US of gangrenous cholecystitis
Sagittal (left) and transverse (right) US of the gallbladder show the gallbladder to be filled with sludge and debris. The gallbladder wall is thickened and in one area was felt to be discontinuous. There were multiple gall stones present in the common bile duct (not pictured).