Porcelain gallbladder refers to extensive calcium encrustation of the gallbladder wall. The term has been used to emphasise the blue discoloration and brittle consistency of the gallbladder wall at surgery. Often an incidental finding on multiple different modalities, CT can be used to confirm the condition with a high degree of accuracy.
Patients are usually asymptomatic, and porcelain gallbladder is found incidentally on plain abdominal radiographs, sonograms, or CT images.
Conventional radiography and CT
The appearance of porcelain gallbladder on both radiography and CT are pathognomonic, demonstrating a thin layer of mineralisation outlining the gallbladder wall.
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
Based on early studies which revealed a high association between porcelain gallbladder and gallbladder adenocarcinoma (22-30% of porcelain gallbladders developing gallbladder adenocarcinoma 3), cholecystectomy has been routinely performed when a porcelain gallbladder is identified.
More recent studies have cast some doubt on the association, and the risk of gallbladder cancer associated with calcification of the wall may be 5-7% 1,4.
There is no accepted follow-up interval, but annual incidence of developing gallbladder cancer is likely to be <1% per year, and CT follow-up is likely unhelpful 4.
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"
- gas: shadowing of air tends to be dirty, rather than the clean anechoic shadow of calcification
Ultrasound - gallbladder
- ultrasound (introduction)
- gallbladder ultrasound
- diffuse gallbladder wall thickening (differential)
- focal gallbladder wall thickening (differential)
- gallbladder sludge
- acute cholecystitis
- chronic cholecystitis
- gallbladder polyp
- porcelain gallbladder
- gallbladder carcinoma
- gallbladder metastases
- gallbladder lymphoma
- gallbladder volvulus / torsion
- variants and anomalies
- 1. Saini S, Rubin GD, Kalra MK. MDCT, a practical approach. Springer Verlag. (2006) ISBN:8847004128. Read it at Google Books - Find it at Amazon
- 2. Kane RA, Jacobs R, Katz J et-al. Porcelain gallbladder: ultrasound and CT appearance. Radiology. 1984;152 (1): 137-41. Radiology (citation) - Pubmed citation
- 3. Grand D, Horton KM, Fishman EK et-al. CT of the gallbladder: spectrum of disease. AJR Am J Roentgenol. 2004;183 (1): 163-70. AJR Am J Roentgenol (citation) - Pubmed citation
- 4. Sebastian S, Araujo C, Neitlich JD et-al. Managing incidental findings on abdominal and pelvic CT and MRI, Part 4: white paper of the ACR Incidental Findings Committee II on gallbladder and biliary findings. J Am Coll Radiol. 2013;10 (12): 953-6. doi:10.1016/j.jacr.2013.05.022 - Pubmed citation