October 17, 2024

Ultrasound of Gallbladder Adenomyomatosis

8 minutes

In this radiology lecture, we review the ultrasound appearance of adenomyomatosis of the gallbladder!

Key teaching points include:

Common cause of benign gallbladder wall thickening seen in up to 9% of patients

Incidence increases with age

Usually asymptomatic, but may be associated with sporadic RUQ pain

Hyperplastic changes of gallbladder wall with mucosal overgrowth. Mucosal herniations protrude into muscular layer forming tiny, bile-filled cystic spaces = Rokitansky-Aschoff sinuses

If large, sinuses may appear as discrete cystic spaces in gallbladder wall

Cholesterol crystals in sinuses cause comet-tail reverberation artifact: Most common finding and highly specific for adenomyomatosis. Can exaggerate comet-tail with addition of color Doppler

Three types: Focal/fundal, segmental/annular and diffuse. Regardless of type, comet-tail artifacts and/or cystic spaces are key to diagnosis

Focal/fundal type: Most common. Often exhibits an “ovary on the gallbladder” appearance. Can be confused with a gallbladder mass. High-frequency linear transducer may be helpful to identify morphology

Segmental/annular type: Narrows waist of gallbladder yielding a figure 8 or hourglass configuration. Gallstones and/or sludge often form in proximal lumen due to increased stasis

If necessary, MRI helpful for problem solving: T2 hyperintense pearl necklace/string of beads appearance sensitive and specific

To learn more about the Samsung RS85 Prestige ultrasound system, please visit: https://www.bostonimaging.com/rs85-prestige-ultrasound-system-4

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By Daniel J. Kowal, MD

4.9

7676 ratings