Porcelain Gallbladder





KEY FACTS


Terminology





  • Intramural calcification of gallbladder (GB) wall, uncommon manifestation of chronic cholecystitis



Imaging





  • Variable posterior acoustic shadowing dependent on quantity of calcification



  • Complete: Thick, diffuse GB wall calcification




    • Hyperechoic semilunar line in GB fossa



    • Dense posterior acoustic shadowing




  • Incomplete: Segmental GB wall calcification




    • Irregular (clumps) hyperechoic foci in GB wall



    • Biconvex curvilinear hyperechogenicity, less shadowing




Top Differential Diagnoses





  • Gallstone-filled GB or large gallstone [wall-echo-shadow (WES) complex]



  • Emphysematous cholecystitis



  • Hyperplastic cholecystosis



Pathology





  • Associated with gallstones in 95%



  • Chronic inflammation/irritation leads to scarring, hyalinization, and dystrophic calcification



  • Risk of GB cancer: 0-5% in incomplete type




    • Complete type: No risk, mucosa entirely denuded




Clinical Issues





  • Rare (< 0.1% at autopsy), more common in women (5:1)



  • Usually occurs in 6th decade



  • Typically asymptomatic; may have biliary-type pain



  • Palpable, firm, nontender mass



Scanning Tips





  • Optimize frequency and focus at level of GB to maximize depiction of calcification and posterior acoustic shadowing



  • Look for soft tissue mass, indicating presence of GB carcinoma




Nov 10, 2024 | Posted by in ULTRASONOGRAPHY | Comments Off on Porcelain Gallbladder

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