Gallbladder Wall Thickening

Focal or diffuse gallbladder wall thickening is most commonly caused by cholecystitis. Noninflammatory conditions that may produce gallbladder wall thickening include heart failure, cirrhosis, hepatitis, hypoalbuminemia, and renal failure. Gallbladder carcinoma should be suggested when there are features of focal mass, lymphadenopathy, extension of the process to adjacent organs, hepatic metastases, or biliary obstruction at the level of the porta hepatis [1]. Xanthogranulomatous cholecystitis (XGC) is a pseudotumoral inflammatory condition of the gallbladder that ra-diologically simulates gallbladder carcinoma. There is a significant overlap in the CT features of XGC and gallbladder carcinoma. Both entities may demonstrate wall thickening, infiltration of the surrounding fat, hepatic involvement, and lymphadenopathy [2, 3]. Adenomyomatous hyperplasia is a common tumor-like lesion of the gallbladder, with no malignant potential [4]. It may produce focal, segmental, or diffuse mural thickening. Sonographically, adenomyomatous hyperplasia is characterized by focal or diffuse gallbladder wall thickening with echogenic foci and ring down artifact emanating from the gallbladder wall [5]. The echogenic foci represent bile salts, cholesterol crystals, or small stones in Rokitansky-Aschoff sinuses. On MR, Rokitansky-Aschoff sinuses are best visualized on breath-hold T2-weighted sequences. Accordingly, MR can be useful to distinguish adenomyomatous hyperplasia from gallbladder carcinoma (Fig. l) [6, 7].


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