三好 広尚, 乾 和郎, 片野 義明, 舘 佳彦, 山本 智支

Hironao MIYOSHI, Kazuo INUI, Yoshiaki KATANO, Yoshihiko TACHI, Satoshi YAMAMOTO

藤田医科大学ばんたね病院消化器内科

Department of Gastroenterology, Bantane Hospital, Fujita Health University School of Medicine

キーワード : Ultrasonography, Adenomyomatosis, Cholecystitis, Gallbladder carcinoma, Xanthogranulomatous Cholecystitis

胆嚢壁肥厚に関連する疾患には，胆嚢腺筋腫症，急性胆嚢炎，慢性胆嚢炎，膵胆管合流異常に伴う過形成などの良性疾患だけでなく，癌も含まれる．硬化性胆嚢炎や免疫チェックポイント阻害薬に関連する胆嚢炎などの特定の疾患は，一部の全身性炎症性疾患と同様に壁肥厚を呈する場合がある．壁肥厚を呈する場合がある疾患のうち最も重篤な胆嚢癌は，早期診断及び壁肥厚の良性原因疾患との鑑別が困難な場合があり，これにより予後不良に至る．壁肥厚を伴う黄色肉芽腫性胆嚢炎と胆嚢癌との鑑別は，特に困難となりうる．癌は壁を肥厚させるが良性病変の併存も壁肥厚を引き起こすことも潜在的なピットフォールである．一方，胆嚢腺筋腫症や急性胆嚢炎などの壁肥厚の原因となる一部の良性胆嚢病変は一般に，臨床所見とともに特徴的な超音波所見を呈するので，容易に診断できる．本文献レビューでは，壁肥厚を呈する胆嚢病変のBモード腹部超音波診断について解説する．

Diseases associated with gallbladder wall thickening include benign entities such as adenomyomatosis of the gallbladder, acute and chronic cholecystitis, and hyperplasia associated with pancreaticobiliary maljunction, and also cancer. Unique conditions such as sclerosing cholecystitis and cholecystitis associated with immune checkpoint inhibitor treatment can also manifest as wall thickening, as in some systemic inflammatory conditions. Gallbladder cancer, the most serious disease that can show wall thickening, can be difficult to diagnose early and to distinguish from benign causes of wall thickening, contributing to a poor prognosis. Differentiating between xanthogranulomatous cholecystitis and gallbladder cancer with wall thickening can be particularly problematic. Cancers that thicken the wall while coexisting with benign lesions that cause wall thickening represent another potential pitfall. In contrast, some benign gallbladder lesions that can cause wall thickening, such as adenomyomatosis and acute cholecystitis, typically show characteristic ultrasonographic features that, together with clinical findings, permit easier diagnosis. In this review of the literature, we describe B-mode abdominal ultrasonographic diagnosis of gallbladder lesions showing wall thickening.