Middle-aged woman with several months of right upper quadrant abdominal pain.
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- The gallbladder wall is grossly thickened and has large low attenuation spaces within the wall which do not communicating with the gallbladder lumen.
- Calculus impacted in the gallbladder neck causing distension of the gallbladder lumen.
- Chronic pancreatitis with parenchyma and ductal stones and pancreatic ductal dilatation.
- Large pseudocyst in the pancreatic head.
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It can be challenging to distinguish benign and malignant gallbladder pathology on imaging, and they may coincide. Here the imaging features are typical of xanthogranulomatous cholecystitis, with dilated hypo-enhancing spaces in the wall. The luminal mucosa is intact throughout.
This is presumed to have occurred secondary to a chronically impacted stone in the neck, raising the intraluminal pressure, and leading to rupture of the Rokitansky-Aschoff sinuses into the wall.
The patient went on to open cholecystectomy. The pathological specimen demonstrated the typical features of XGC within the wall: foamy lipid-laden macrophages, bile pigment and chronic inflammatory cells.