Gallbladder adenomyomatosis

Case contributed by Dr Laughlin Dawes
Ultrasound

Echogenic foci with V-shaped comet tail artifact at the fundus of the gallbladder.

Case Discussion

Adenomyomatosis is a benign hyperplastic condition of the gallbladder consisting of hyperplasia of the gallbladder wall with hernation of mucosal epithelium into the wall. The latter results in intramural diverticula lined by epithelium, also known as Rokitansky-Aschoff sinuses. Cholesterol crystals, sludge or stones often precipitate within the bile trapped within these sinuses. Adenomyomatosis may involve the gallbladder diffusely but is usually focal, most commonly in the fundus.

Ultrasound often demonstrates non-specific gallbladder wall thickening. Small echogenic foci within the wall with V-shaped comet tail artefact, as shown in this case, represents cholesterol crystals within the Rokitansky-Aschoff sinuses. This finding, when present, is highly specific for gallbladder adenomyomatosis. Hyperechoic sludge and stones may also be seen within the sinuses in the wall.

Gallbladder adenomyomatosis is usually an asymptomatic incidental finding but may rarely cause abdominal pain. There is no malignant potential.

Credit: Dr Donna D'Souza.

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Case information

rID: 36056
Case created: 24th Apr 2015
Last edited: 6th Nov 2015
Inclusion in quiz mode: Included

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