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Roentgen Visualization of the Rokitansky-Aschoff Sinuses as an Additional Sign of Chronic Gallbladder Disease

1953; Radiological Society of North America; Volume: 60; Issue: 5 Linguagem: Inglês

10.1148/60.5.714

1527-1315

Robert Sukman, Paul B. Daron,

Cancer Diagnosis and Treatment

The radiological visualization of the Rokitansky-Aschoff sinuses is considered by many as of only academic interest. The case to be reported here, however, illustrates the clinical accuracy of their demonstration as evidence of chronic gallbladder disease. In the normal healthy gallbladder one rarely sees what are considered to be the Rokitansky-Aschoff sinuses. This term can be applied only to the deep outpouchings of mucosa extending into or through the muscular coat and into the perimuscular layers, leading to separation of the interstices and delicate walls of the muscle bundles. Normally the gallbladder muscle bundles are resistant to such outpouchings. In the presence of inflammation, however, these contractile structures become weakened. With obstruction and chronic over-distention, the mucosa can readily herniate through the intermuscular septa and extend into the perimuscular tissues, even reaching the serosa. Pathologically the gallbladder in which Rokitansky sinuses are found is usually thickened as a result of chronic inflammatory changes, with the usual inflammatory infiltration of the connective tissues and associated proliferation of fibroblasts and edema. These changes are rarely detected on the roentgenogram because of the reduced contractibility of the gallbladder and its inability to concentrate the usual opaque media. The pathologist has long used the microscopic and gross detection of Rokitansky-Aschoff sinuses as a basis for diagnosis of chronic gallbladder disease, even in the absence of other changes. As early as the seventeenth century pathologists demonstrated gland-like, branched mucosal outpouchings in the gallbladder walls. It was not until 1861, however, that von Rokitansky (10) adequately described these hernia-like outpouchings, not as true glands, but as herniations of the mucosa extending into the deeper layers of the walls and at times containing small concretions. Halpert (6) later differentiated these sinuses from the true Luschka ducts, which are actually accessory bile ducts joining the liver through the cystic bed. Aschoff (3) later showed that the mucosa of the gallbladder lacks a muscularis mucosae and that the underlying tunica muscularis is somewhat thinly spread and of irregular structure. Through this muscular network penetrate the blood vessels. These potential intermuscular spaces are often separated by increased intracystic tension with associated herniation of the mucosa. This latter observation is of interest in that in all cases of roentgenologically demonstrated Rokitansky-Aschoff sinuses reported there has been present an associated stricture of the proximal portion of the gallbladder. Robertson and Ferguson (9) of the Mayo Clinic found some herniation of the mucosa in 50 per cent of gallbladders of persons over the age of thirty.