title: Cholesterol crystal morphology in acalculous gallbladder disease.
abstract: BACKGROUND
  Biliary crystal morphology is best described in patients with gallbladder stones, but most patients undergoing bile collection for microscopy have a clinical diagnosis of acalculous gallbladder disease. We investigated the morphology of biliary crystals in such patients.
  
  
  METHODS
  Bile was obtained for polarizing microscopy from fresh cholecystectomy specimens of patients with a clinical diagnosis of acalculous or calculous gallbladder disease. Slides for microscopy were prepared by touch contact with bile in freshly opened gallbladder specimens, and following aspiration of gallbladder bile through a 5-French cannula.
  
  
  RESULTS
  Bile was examined from five patients with a clinical diagnosis of acalculous gallbladder disease and five patients with known gallstones. Needle-like cholesterol crystals predominated in most patients without gallstones, whereas plate-like and dot-like crystals were more common in patients with gallstones. All three crystal types were seen in most patients. Crystal morphology was not affected by aspiration of bile through a 5-French cannula.
  
  
  CONCLUSIONS
  Birefringent needles and dots should be recognized as cholesterol crystals during bile microscopy. These crystal morphologies may predominate in some patients with a clinical diagnosis of acalculous gallbladder disease.
authors.affiliation: Department of Pathology, Yale University School of Medicine, New Haven, Connecticut, USA.
authors.forename: Kristin
authors.initials: K
authors.lastname: Landi
authors.forename: John
authors.initials: J
authors.lastname: Sinard
authors.forename: James M
authors.initials: JM
authors.lastname: Crawford
authors.forename: Mark
authors.initials: M
authors.lastname: Topazian
mesh_terms: D000328:Adult; D000368:Aged; D001646:Bile / Q000737:chemistry; D001659:Biliary Tract / Q000503:physiopathology; D002137:Calculi / Q000737:chemistry / Q000648:ultrastructure*; D002675:Child, Preschool; D002764:Cholecystitis / Q000175:diagnosis / Q000209:etiology; D002784:Cholesterol / Q000737:chemistry*; D003460:Crystallization; D005260:Female; D005705:Gallbladder Diseases / Q000175:diagnosis* / Q000209:etiology; D006801:Humans; D008297:Male; D008859:Microscopy, Polarization; D008875:Middle Aged; D010195:Pancreatitis / Q000175:diagnosis / Q000209:etiology; D011237:Predictive Value of Tests; D018570:Risk Assessment; D012494:Sampling Studies; D012680:Sensitivity and Specificity
chemical_list: D002784:Cholesterol