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Journal of Medical Ultrasonics

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1997 - Vol.24

Vol.24 No.11

Case Report(症例報告)

(1761 - 1765)

胆嚢腺筋腫症にみられるComet-tail Artifactの成因としての壁内結石: コレステロール結晶石

Intramural Gallstones as an Acoustic Origin of Comet-tail Artifact Seen in Adenomyomatosis of the Gallbladder: Cholesterol-Crystal Stone

矢島 義昭1, 宮崎 敦史1, 枝 幸基1, 西岡 可奈1, 渋谷 大助1, 大平 誠一1, 長沼 廣2

Yoshiaki YAJIMA1, Atsushi MIYAZAKI1, Yoshiki EDA1, Kana NISHIOKA1, Daisuke SHIBUYA1, Seiichi OOHIRA1, Hiroshi NAGANUMA2

1仙台市立病院消化器科, 2仙台市立病院病理科

1Department of Gastroenterology, Sendai City Hospital, 2Department of Pathology, Sendai City Hospital

キーワード : Comet-tail artifact , Cholesterol-crystal stone , Intramural gallstone , ultrasonography

Ultrasonographic examination disclosed diffuse wall thickening and coment-tail artifact in two cases of adenomyomatosis (ADM) of the gallbladder, and laparoscopic cholecystectomy was performed. In case 1, found in a 41-year-old man, the excised gallbladder showed general thickening of the wall and multiple intramural gallstones in the dilated Rokitansky-Aschoff sinuses (RAS). These stones were mainly cholesterol-crystal stones like those described by Yunotani: square, transparent, crystalloid stones with glittering glasslike surfaces; and a smaller number of mixed stones consisting of cholesterol and pigment. Water-bath scan of the removed stones showed only the cholesterol-crystal stones to have the typical comet-tail artifact. Infrared spectrometry of one of the cholesterol-crystal stones showed cholesterol content to exceed 98% , In case 2, found in a 36-year-old man, the excised gallbladder also showed general thickening of the wall, and the dilated RAS contained numerous black intramural stones and several cholesterol-crystal stones. Water-bath scan of the gallbladder showed comet-tail artifacts like those seen in the extracorporal ultrasonogram. Water-bath scan of the removed stones showed only the cholesterol-crystal stones to produce comet-tail artifacts. These results suggest that cholesterol-crystal stones, characteristic of intramural gallstones, may be the origin of the comet-tail artifact seen in ADM of the gallbladder.