Diffuse gallbladder wall thickening (differential)

Diffuse thickening of the gallbladder wall can occur in a number of situations:

• cholecystitis

  • acute cholecystitis

  • chronic cholecystitis

  • gallbladder empyema ⁷

  • xanthogranulomatous cholecystitis ¹¹

  • acalculous cholecystitis ¹¹

• postprandial physiological state (pseudothickening)

  • gallbladder overall decompressed

• secondary thickening

  • hepatic cirrhosis

  • hepatitis

  • congestive right heart failure

  • Fitz-Hugh-Curtis syndrome

  • hypoalbuminemia ⁶

  • ascites ^9,12

  • other acute inflammatory processes in the right upper quadrant

    • acute pancreatitis

    • perforated duodenal ulcer ⁸

    • acute pyelonephritis ¹⁵

    • peritonitis ¹²

  • primary sclerosing cholangitis ^10,11

    • rarely a direct cause - mostly in the setting of concurrent hypoalbuminemia and/or liver failure

    • gallbladder wall thickening related to involvement of primary sclerosing cholangitis is controversial ¹⁰

  • gallbladder perforation ⁹

  • brucellosis ¹¹

  • dengue fever ¹⁷

  • AIDS cholangiopathy ⁹

  • severe pyelonephritis ¹²

  • renal failure ¹¹

• gallbladder carcinoma

  • a minority present as focal or diffuse wall thickening (20-30%) ^11,12

  • suspicious features include marked asymmetric wall thickening and irregularity ¹²

• diffuse adenomyomatosis of the gallbladder

  • associated with classic comet tail artifact ¹¹

  • associated with epithelial enhancement on CT ¹¹

• ^​hemophagocytic lymphohistiocytosis (HLH) ¹³