Porcelain gallbladder

Radswiki et al.

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. 

Ultrasound

On ultrasound, the gallbladder demonstrates dense shadowing, which could be mistaken for gas in the gallbladder wall (emphysematous cholecystitis) or gallstones in the lumen of the gallbladder. 

MRI

Because of MRI's inferior ability to detect calcification, relative to CT, it does not play a significant role in imaging the condition.

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:

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rID: 12408
Section: Signs
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