I am a surgeon with special interest in hepatobiliary as well as emergency surgery. This is a common ultrasonographic finding in patients with heart failure. Especially in right-sided heart failure, impeded venous outflow from the liver causes hepatic congestion and dilation (and can actually cause upper abdominal pain). Since the gallbladder wall venous drainage is through direct veins to the liver parenchyma, it is theorized that the hepatic venous congestion also causes increased portal vein pressure and hence decreased venous drainage and oedema of the gallbladder wall.

Sometimes the differential diagnosis is difficult, especially with acute acalculous cholecystitis, which is often found in patients with severe co-morbid medical conditions.

J Clin Ultrasound. 1987 Jun;15(5):307-12.

Gallbladder wall thickening: a frequent finding in various nonbiliary disorders--a prospective ultrasonographic study.

Wegener M1, Börsch G, Schneider J, Wedmann B, Winter R, Zacharias J.

I am agreed with Dr.Alexandrino's answer.

The gallbladder wall thickening is just a kind of congestive oedema that is a frequent finding at any kind of suprahepatic portal hypertension including the congestive heart failure; sometimes in cirrhotic patients with ascites.

How to differentiate this rather common condition from by far less frequent the acute acalculous cholecystitis, is a challenge. The Tokyo guidelints for the acute cholecystitis may be useful for this.

Congestive heart failure can induced hepatic congestion and ascitis, I think .gallbladder and glison capsule also can involved.and wall thickness is common. particularly with gallstone, misdiagnosis of cholecystitis , can be harmful and unnecessary surgery.

Unfortunately, the Tokyo guidelines won't help much in distinguishing cholecystitis in this context. The Imaging features include thickening of the gallbladder wall over 4 mm only after excluding chronic liver disease, right sided heart failure and ascitis. However, ultrasound could help in identifying right sided heart overload by measuring the diameter of the vena cava and the supra-hepatic veins. 

Mayumi, T., Takada, T., Kawarada, Y., Nimura, Y., Yoshida, M., Sekimoto, M., et al. (2007). Results of the Tokyo Consensus Meeting Tokyo Guidelines. Journal of Hepato-Biliary-Pancreatic Surgery, 14(1), 114–121. http://doi.org/10.1007/s00534-006-1163-8

Moreover, there are other entities that could produce this feature, thickened gallbladder wall. In a paper recently published, we show that acute pancreatitis could mimic acute cholecystitis in that matter and create false Tokyo guidelines imaging features of acute cholecystitis. The study is retrospective but the statistic power is significant.

Pereira, J., Afonso, A. C., Constantino, J., Matos, A., Henriques, C., Zago, M., & Pinheiro, L. (2015). Accuracy of ultrasound in the diagnosis of acute cholecystitis with coexistent acute pancreatitis. European Journal of Trauma and Emergency Surgery. http://doi.org/10.1007/s00068-015-0619-4

It is process of generalized congestion and oedema like pedal oedema, ascites, hepatic and gall bladder oedema. It reverses back one the  once the heart failure improves.

Dr.Pereira,

You are absolutely right in that that both the Tokyo guidelines are not perfect and the acute pancreatitis may produce the gallbladder wall thickening.

However, there are another criteria suggested in the TGs, and they are deserved to be mentioned:

1. Length of the gallbladder is longer than 8 cm;

2. Width of the gallbladder is wider than 4 cm;

3. Gas and sloughs in the GB lumen;

4. Gas in the GB wall;

5. US Murphy's sign;

6. Characteristic clinical manifestations of AC (last, but not least).

All the items aforementioned will not be present in a patient with congestive heart disease or other cause of the suprahepatic portal hypertension syndrome.

Also, the acute pancreatitis may cause the gallbladder wall oedema (along with  other intra- and extraabdominal organs) for some known and unknown reasons, and not the oedema only, but the real acute cholecystitis may occur including the gangrene of the organ. I have not met any studies dedicated the subject of differentiating the former and the latter without laparoscopy or laparotomy yet, so do I not know myself how to solve this problem.

Happy New Year to all the researchers!

As Henrique Alexandrino noted above, this is a common occurrence that is directly related to passive hepatic congestion from the volume overloaded state and not necessarily a cholestatic state. 

ALP levels are often elevated in the absence of transaminase elevation, as this is believed to be related to the back pressure created on the IVC and hepatocytes from elevated right atrial and right ventricular pressures/volume. This is common in chronic heart failure patients. This may represent an acute finding, but often persists chronically and carries a higher 180-day mortality.

Pan-LFT elevation can also be seen, particularly if there is a forward (left heart) failure component that is simultaneously occurring, and therefore the transaminase elevation likely represents hepatic ischemia as a result of poor forward flow via the hepatic artery. Transaminase elevation secondary to heart failure carries a higher 30-day and 180-day mortality rate.

Pan LFT elevation is also present, of course, when there is hypotension with heart failure, and therefore represents shock liver. Those numbers will correct with hemodynamic stability and restoration of blood flow to vital organs.

A simple way to summarize:

ALP elevation= backward (right pump) failure

ALT/AST elevation = forward (left pump) failure

"Liver function abnormalities, clinical profile, and outcome in acute decompensated heart failure"; European Heart Journal, Maria Nikolaou, John Parissis, M. Birhan Yilmaz, Marie-France Seronde, Matti Kivikko, Said Laribi, Catherine Paugam-Burtz, Danlin Cai, Pasi Pohjanjousi, Pierre-François Laterre, Nicolas Deye, Pentti Poder, Alain Cohen Solal, Alexandre Mebazaa

DOI: http://dx.doi.org/10.1093/eurheartj/ehs332 ehs332 First published online: 22 October 2012

Best regards.