Adenomyomatosis of the gallbladder

Case contributed by Michał Czerny
Diagnosis certain


Incidental findings in the gallbladder on CT examination that was initially performed to evaluate a large renal cyst.

Patient Data

Age: 65 years
Gender: Female

T2 WI fat saturated thin...


T2 WI fat saturated thin section

These are thin-section axial plane T2WI fat-saturated images as a part of abdomen examination made to evaluate gallbladder findings in a CT exam that was ordered to confirm benign character of a large renal cyst (on the left). The wall of the fundus and distal body of the gallbladder contain multiple cystic intramural diverticula with lumen narrowing which give the characteristic pearl necklace sign appearance. 

Case Discussion

This female patient had a CT to evaluate a renal cyst (seen on the left). Indeterminate gallbladder appearance was found with a suspicion of an inflammatory process or a tumor. Clinicians decided to evaluate this patient in abdominal MR with cholangiopancreatographic sequences. 

Final diagnosis of gallbladder adenomyomatosis can be made with certainty noting the characteristic findings - intramural cystic diverticula with lumen narrowing without any nodular enhancing content (pearl necklace sign). 

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