Gallbladder Sludge

• Biliary or gallbladder sludge is bile that has thickened within the gallbladder and is a mixture of bile, cholesterol, salt, and calcium and may be the precursor to gallstones.
• Gallbladder sludge, like gallstones, may block the neck of the gallbladder or cystic ducts creating a pressure build-up within the gallbladder leading to inflammation and/or infection of the gallbladder.
• The ultrasound appearance of gallbladder sludge is echogenic and often does not produce an acoustic shadow.  
• Gallbladder sludge may often be misidentified as stomach or bowel contents, but it is gravitationally dependent and will layer out within the gallbladder.

Gallbladder sludge may often be misidentified as bowel gas.

Gallbladder sludge appearance:

• Echogenic
• Does not produce an acoustic shadow
• Often a pre-cursor to gallstones
• Will layer with gravitational dependency

Be sure to roll the patient to evaluate for sludge movement.