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
  • 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