Diagnostic Ultrasound - Abdomen and Pelvis

Porcelain Gallbladder
Diagnoses: Biliary System
TERMINOLOGY
• Intramural calcification of gallbladder wall, uncommon
manifestation of chronic cholecystitis
IMAGING
• Type of calcification determines the ultrasound appearance
○ Thick diffuse GB wall calcification (complete)
○ Segmental GB wall calcification (incomplete)
• Set focus to maximize depiction of high-amplitude echoes
and dense posterior acoustic shadowing
• Look for soft tissue mass in gallbladder or fossa, indicating
presence of GB carcinoma
TOP DIFFERENTIAL DIAGNOSES
• Gallstone-filled gallbladder or large gallstone
○ Wall-echo-shadow (WES) complex appearance
○ Mobile stones may be positional
○ Dense, clean posterior acoustic shadowing (should not
see posterior wall)
KEY FACTS
• Emphysematous cholecystitis
○ Echogenic crescent in gallbladder
○ Irregular (dirty) posterior acoustic shadowing
• Hyperplastic cholecystosis
○ Diffuse or focal GB wall thickening, echogenic foci with
"comet tail" artifacts
○ No posterior acoustic shadowing
PATHOLOGY
• Associated with gallstones in 95%
CLINICAL ISSUES
• Risk of gallbladder cancer: 0-5%
○ Complete type: No risk, mucosa entirely denuded
○ Incomplete type: Mucosal metaplasia → dysplasia
• Prophylactic cholecystectomy is appropriate for healthy
patients
• Nonoperative approach can be considered in patients with
significant comorbidity
(Left) Grayscale US shows a
thin, hyperechoic semilunar
line in the GB fossa with
dense posterior acoustic
shadowing ſt in a 67-year-old
woman who presented with
chronic intermittent biliary
pain as an example of
complete calcification. (Right)
Curvilinear diffuse, thin
calcifications are shown in the
RUQ of the same patient, in
the expected location and
shape of the gallbladder.
(Courtesy American Institute
for Radiologic Pathology
archives, Case ID #2133052.)
(Left) Discontinuous
hyperechoic foci in the
anterior ſt and posterior
GB wall, with variable
shadowing , in a 67-yearold
woman with RUQ pain
after eating; an example of
incomplete calcification.
(Right) Punctate mural
calcifications ſt in a 61-yearold
obese man, an example of
incomplete calcification.
Gallstones found at pathology
are not shown. (Courtesy
American Institute for
Radiologic Pathology archives,
Case IDs #2674992, #642.)
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