HYPERPLASTIC GALLBLADDER WALL IMAGING
Category: Diagnostic Radiology
Abstract : HYPERPLASTIC CONDITIONS OF THE GALLBLADDER WALL Adenomyomatosis This is
a non-inflammatory, hyperplastic condition which causes gallbladder wall
thickening. It may be mistaken for chronic cholecystitis on ultrasound. The
epithelium which lines the gallbladder wall undergoes hyperplastic change,
extending diverticula into the adjacent muscular layer of the wall. These
diverticula, o
HYPERPLASTIC CONDITIONS OF THE GALLBLADDER WALL
Adenomyomatosis
This is
a non-inflammatory, hyperplastic condition which causes gallbladder wall
thickening. It may be mistaken for chronic cholecystitis on ultrasound. The
epithelium which lines the gallbladder wall undergoes hyperplastic change,
extending diverticula into the adjacent muscular layer of the wall.
These
diverticula, or sinuses (known as Rokitansky–Aschoff sinuses), are visible
within the wall as fluid-filled spaces, which can bulge eccentrically into the
lumen, and may contain echogenic material or even (normally pigment) stones. The
wall thickening may be focal or diffuse, and the sinuses may be little more than
hypoechoic ‘spots’ in the thickened wall, or may become quite large cavities in
some cases. Deposits of crystals in the gallbladder wall frequently result in
distinctive ‘comet-tail’ artefacts. Often asymptomatic, this may present with
biliary colic although it is unclear whether this is caused by co-existent
stones. Its distinctive appearance allows the diagnosis to be made easily,
whether or not stones are present. Cholecystectomy is performed in symptomatic
patients, usually those who also have stones. Although essentially a benign
condition, a few cases of associated malignant transformation have been
reported, usually in patients with associated anomalous insertion of the
pancreatic duct.
Polyps
Gallbladder polyps are usually asymptomatic
lesions which are incidental findings in up to 5% of the population.
Occasionally they are the cause of biliary colic. The most common type are
cholesterol polyps. These are reflective structures which project into the
gallbladder lumen but do not cast an acoustic shadow. Unless on a long stalk
they will remain fixed on turning the patient and are therefore distinguishable
from stones. There is an association between larger adenomatous gallbladder
polyps and subsequent carcinoma, especially in patients over 50 years of age, so
cholecystectomy is often advised. Smaller polyps of less than 1 cm in diameter
may be safely monitored with ultrasound. In particular, gallbladder polyps in
patients with primary sclerosing cholangitis have a much greater likelihood of
malignancy (40–60%).
Cholesterolosis
Also known as the ‘strawberry
gallbladder’, this gets its name because of the multiple tiny nodules on the
surface of the gallbladder mucosal lining. These nodules are the result of a
build-up of lipids in the gallbladder wall and are not usually visible on
ultrasound. However in some cases, multiple polyps also form on the inner
surface, projecting into the lumen, and are clearly visible on ultrasound.
Cholesterolosis may be asymptomatic, or may be accompanied by stones and
consequently requires surgery to alleviate symptoms of biliary colic.
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