Gallbladder sludge formation after bone marrow transplant: sonographic observations.

We prospectively studied 12 patients before and after bone marrow transplantation (BMT) with serial sonography to evaluate gallbladder sludge formation. Patients were studied on four separate occasions to assess the gallbladder for sludge and stones: prior to BMT and conditioning chemoradiation, and on days 3, 13, and 28 after BMT. During two of the sonographic studies, gallbladder volume measurements were made before and after administration of cholecystokinin octapeptide (CCK-OP) and the ejection fraction (EF) was calculated. Medical records were reviewed for symptoms of cholecystitis, narcotic use, and dietary intake. Sludge and/or stones developed in eight of 12 patients (67%), and in four patients sludge was observed by day 3 post-BMT. Ejection fraction was normal (> 50%) pre-BMT in six of the eight patients who developed sludge, and in four of these six post-BMT. Furthermore, five of the eight patients developed sludge and/or stones in the absence of fasting and/or narcotic use. We conclude that gallbladder sludge develops frequently and early in BMT patients and may resolve or progress to stone formation. We did not demonstrate a relationship between impaired contractility and the development of sludge and/or stones, nor did we find a strong association between sludge formation and conditions presumed to cause gallbladder stasis, such as narcotic use and fasting. These findings suggest that other factors apart from impaired gallbladder contractility may play a role in the formation of sludge in the BMT patient.

Venocclusive disease of the liver: prospective study of US evaluation.

Twenty-one bone marrow transplantation (BMT) patients were studied prospectively to determine the prevalence of sonographic hepatobiliary abnormalities and to determine if these abnormalities were associated with hepatic venocclusive disease (VOD). Baseline US was performed in all patients prior to chemoradiation therapy, with follow-up ultrasound (US) examinations at the time of BMT and 14 days and 28 days after BMT. Sonograms were reviewed for the presence of ascites, gallbladder wall thickening, hepatosplenomegaly, hepatofugal flow, hepatic vein compression, increased periportal echogenicity, and increased hepatic echotexture. The baseline scans showed 13 of 21 patients (62%) with abnormalities prior to BMT. Within 2 weeks after BMT, serial US showed interval development of hepatomegaly in five patients (three with VOD and two without), gallbladder wall thickening in one (with VOD), hepatic vein compression in two (both with VOD), hepatofugal flow in one (without VOD), and ascites in one (with VOD). US scans obtained 4 weeks after BMT in 15 of the 21 patients showed even fewer new abnormalities. No sonographic finding was strongly associated with VOD.