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Case of the Month

February 2010

Patient Data: Male 71 years old

Clinical Info: Vague pain in the upper abdomen. The laboratory findings are normal.

Longitudinal image of the gallbladder with an abnormally thickened wall especially in the central part of the gallbladder. The cranial part of the gallbladder is relatively normal. There are multiple small diverticula in the thickened part of the gallbladder wall. No gallstones were found.

Longitudinal image of the gallbladder fundus also showing a thickened wall with small divericula. In some of them there are hyperechoic foci.

Transverse image of the gallbladder fundus showing a thickened wall with small diverticula and hyperechoic foci.

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The diagnosis is an adenomyomatosis which is a benign hyperplastic cholecystosis. It is a relatively common condition .
Adenomyomatosis is most often an incidental finding. It has no malignant potential, and usually requires no treatment. The hyperechoic foci are precipitated cholesterol crystals in the bile trapped in the intramural diverticula called Rokitansky-Aschoff sinuses The small diverticula are best seen with a high frequency probe.

Gallbladder involvement by adenomyomatous hyperplasia is variable in extent and location, with heterogeneous imaging appearances corresponding to diffuse, segmental, and focal adenomyomatosis. This case represents a segmental form.

Sometimes adenmyomatosis can lead to abnormal gallbladder contractions which may result in vague abdominal complaints.

The differential diagnosis include a cholecystitis and a gallbladder carcinoma. In most cases however the diagnosis will not be a problem.

For more examples of adenomyomatosis see category

Copyright © Dr. T.S.A. Geertsma, Ziekenhuis Gelderse Vallei, Ede, The Netherlands. All rights reserved.

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