KEY FACTS
Imaging
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Gallbladder (GB) wall thickening with intramural hyperechoic foci and comet-tail reverberation artifacts
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V-shaped comet-tail artifacts from debris in GB wall cystic spaces
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Twinkling artifacts from intramural debris on color Doppler examination
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Morphological patterns: Diffuse, segmental, annular, focal
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Annular form: Midbody segmental thickening results in constricting ring around midbody and hourglass shape
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Focal fundal adenomyoma
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Smooth fundal solitary intraluminal mass, internal cystic spaces, echogenic foci
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No significant vascularity; ± twinkling artifact
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Top Differential Diagnoses
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GB carcinoma
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Emphysematous cholecystitis
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Chronic cholecystitis
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Adenomatous polyp (fundal form)
Pathology
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GB wall thickening resulting from epithelial proliferation and muscle hyperplasia leading to formation of intramural diverticula (Rokitansky-Aschoff sinuses) filled with bile, cholesterol crystals, sludge, or calculi
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Gallstones in up to 90%
Clinical Issues
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9% prevalence in cholecystectomy specimens
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F > M; mean age: > 50 years
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Most often asymptomatic; or biliary pain/dyspepsia
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No conclusive evidence of increased cancer risk
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No clinical significance in asymptomatic patients when diagnosed correctly and differentiated from carcinoma
Scanning Tips
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Use higher frequency transducer for visualization of comet-tail artifacts and cystic spaces; evaluate GB fundus
.
. There is a comet-tail artifact associated with an echogenic focus 
in this patient with fundal adenomyomatosis.
. There are stones 
in the fundus, where the wall is less thick.
emanating from debris in Rokitansky-Aschoff sinuses. The sinuses themselves are not visible. Note reverberation artifact 
from adjacent bowel.Related posts:
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