Chronic inflammation of gallbladder (GB) causing wall thickening and fibrosis

Presence of gallstones in nearly all cases

Diffuse symmetric GB wall thickening without hyperemia

Pericholecystic inflammation usually absent

Poor GB distension despite fasting

Localized tenderness usually mild, unlike acute cholecystitis

US is initial imaging tool

HIDA scan distinguishes acute from chronic cholecystitis

Acute cholecystitis

Diffuse GB wall thickening from portal hypertension or heart failure

Adenomyomatosis of GB

GB carcinoma

Most common pathology of GB

95% associated with gallstone disease

Intermittent obstruction of cystic duct causes chronic inflammatory infiltration of wall

Variant: Xanthogranulomatous cholecystitis, mimics carcinoma

Female > male, middle age, obesity

Mild intermittent right upper quadrant pain/discomfort after meal or asymptomatic

Complications include recurrent acute cholecystitis, biliary colic, GB carcinoma, and, rarely, biliary-enteric fistula

Look for asymmetric wall thickening, which would suggest malignancy rather than chronic cholecystitis