KEY FACTS
Terminology
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Intramural calcification of gallbladder (GB) wall, uncommon manifestation of chronic cholecystitis
Imaging
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Variable posterior acoustic shadowing dependent on quantity of calcification
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Complete: Thick, diffuse GB wall calcification
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Hyperechoic semilunar line in GB fossa
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Dense posterior acoustic shadowing
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Incomplete: Segmental GB wall calcification
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Irregular (clumps) hyperechoic foci in GB wall
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Biconvex curvilinear hyperechogenicity, less shadowing
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Top Differential Diagnoses
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Gallstone-filled GB or large gallstone [wall-echo-shadow (WES) complex]
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Emphysematous cholecystitis
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Hyperplastic cholecystosis
Pathology
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Associated with gallstones in 95%
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Chronic inflammation/irritation leads to scarring, hyalinization, and dystrophic calcification
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Risk of GB cancer: 0-5% in incomplete type
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Complete type: No risk, mucosa entirely denuded
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Clinical Issues
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Rare (< 0.1% at autopsy), more common in women (5:1)
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Usually occurs in 6th decade
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Typically asymptomatic; may have biliary-type pain
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Palpable, firm, nontender mass
Scanning Tips
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Optimize frequency and focus at level of GB to maximize depiction of calcification and posterior acoustic shadowing
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Look for soft tissue mass, indicating presence of GB carcinoma
