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Gallbladder adenomyomatosis

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Ultrasound and MRI image showing gallbladder adenomyomatosis
Ultrasound and MRI images showing gallbladder adenomyomatosis

Quiz

Which of the following sign is NOT seen in adenomyosis?

  1. Rosary bead sign
  2. Comet Tail Sign
  3. Pearl Necklace Sign
  4. None of the above.
Click here for the answer

Pathophysiology

Decreased bile excretion increases intraluminal pressure in the gall bladder which leads to the proliferation of surface epithelium with outpouchings into thickened muscularis propria giving rise to intramural diverticula (also known as Rokitansky-Aschoff sinuses)

Key Imaging Features 

  • US: Focal or segmental wall thickening with intramural echogenic foci and comet-tail reverberation artifacts as shown in the above image.
  • MRI: Focal (most commonly at the fundus)or segmental wall thickening with intramural cysts (pearl necklace sign)
  • CT: Not well seen on CT. Focal thickening at the fundus. CT rosary sign can be seen due to the intramural diverticula surrounded by the unenhanced hypertrophied muscle coat of the gallbladder. 

Imaging Recommendation : 

Ultrasound is diagnostic for adenomyomatosis and no further imaging is needed in most cases. 

Top 3 Differential Diagnosis : 

  • Gallbladder Carcinoma:  Infiltrative and ill-defined margin, vascular lesion, invasion into adjacent organs, and metastatic lymphadenopathy.
  • Chronic Cholecystitis: Contracted gallbladder with diffuse wall thickening.
  • Xanthogranulomatous Cholecystitis: Infiltrative nodular gallbladder wall thickening without comet tail artifact.

Clinical Features : 

  • Usually asymptomatic. Can rarely cause biliary colic.
  • Not premalignant but can cause chronic GB inflammation, which is a risk factor for gall bladder malignancy.

Classification System if any : 

  • Focal: Most common subtype. Focal fundal thickening.
  • Segmental: Circumferential thickening causing a constriction in the gallbladder. The distal portion is usually filled with calculi.
  • Diffuse: Diffuse thickening with multiple intramural diverticula.

Etymology and synonyms : 

  • Also known as Hyperplastic Cholecystosis
  • Adeno – Glands | Myoma – muscle tumors | osis – condition 

Treatment : 

  • Cholecystectomy in symptomatic patients. 

References: 

Single best review article: 

Golse N, Lewin M, Rode A, Sebagh M, Mabrut JY. Gallbladder adenomyomatosis: Diagnosis and management. J Visc Surg. 2017;154(5):345-353. doi:10.1016/j.jviscsurg.2017.06.004

Other references: 

Yu MH, Kim YJ, Park HS, Jung SI. Benign gallbladder diseases: Imaging techniques and tips for differentiating with malignant gallbladder diseases. World J Gastroenterol. 2020;26(22):2967-2986. doi:10.3748/wjg.v26.i22.2967

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