Adenomyomatosis of gallbladder
Patient attended for a health check up. She complained of vague, intermittent, dull ache in right upper quadrant.
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Gallbladder wall thickening with echogenic foci giving a comet tail appearance. Multiple small gallstones are visualized. No pericholecystic fluid present. Murphy’s sign is negative.
Adenomyomatosis of gallbladder is a relatively common and often incidental finding, and has no intrinsic malignant potential. It requires no specific treatment and is often seen with gallstones. Thickening of gallbladder wall occurs due to hyperplasia of the mucosa and muscularis propria. Cholesterol crystals accumulate intraluminally within intramural diverticula known as Rokitansky-Aschoff sinuses. These results in the characteristic echogenic intramural foci with V shaped or comet tail artifacts.
Gallbladder wall thickening with stones and sludge are commonly seen together with adenomyomatosis.
Adenomyomatosis can be difficult to differentiate from cholesterosis of gallbladder; however, wall thickening is not present in the latter diagnosis.