Porcelain gallbladder refers to extensive calcium encrustation of the gallbladder wall. The term has been used to emphasize the blue discolouration and brittle consistency of the gallbladder wall at surgery but is often an incidental finding on multiple different imaging modalities.
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Clinical presentation
Patients are usually asymptomatic, and porcelain gallbladder is usually found incidentally on plain abdominal radiographs, ultrasound, or CT images.
Radiographic features
Ultrasound
On ultrasound, the gallbladder demonstrates echoes and posterior dense shadowing, with usually poor delineation of the gallbladder wall itself. This could be mistaken for gas in the gallbladder wall (emphysematous cholecystitis).
Plain radiograph and CT
The appearance of porcelain gallbladder on both radiography and CT are pathognomonic, demonstrating a thin layer of mineralization outlining the gallbladder wall.
MRI
Because of MRI's inferior ability to detect calcification, relative to CT, it does not play a significant role in imaging the condition.
Treatment and prognosis
The latest study has showed the incidence of coexisting gall bladder carcinoma in case of calcified gallbladder wall is not higher then in general population (about 6 %) 5.
However, prophylactic laparoscopic cholecystectomy is still recommended due to high morbidity and mortality of gallbladder cancer, but some reports say that conservative therapy with serial ultrasound follow up may be considered in asymptomatic cases 6,7.
There is no accepted follow-up interval, but the annual incidence of developing gallbladder cancer is likely to be <1% per year, and CT follow-up is likely to be unhelpful 4.
Differential diagnosis
On ultrasound, also consider:
gallstones / wall-echo-shadow sign: there should be a thin hypoechoic bile space between the gallbladder "wall" and the gallstone "echo"
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gas: shadowing of air tends to be dirty, rather than the clean anechoic shadow of calcification
adjacent bowel is mistaken for gallbladder
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