Thick bile may appear as a nonshadowing, dependent, echogenic layer within the gallbladder. In vivo sonographic imaging of the canine gallbladder showed that highly viscous, desiccated bile appeared echogenic and could potentially prevent imaging an enlarged gallbladder or dilated bile ducts. Selected clinical cases demonstrated that multiple nonshadowing calculi, pus, cholesterol crystals, and possibly abnormal mucous in the gallbladder may be sonographically indistinguishable from thick bile.
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Conrad et al. (1979) studied this question.
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