(Left) Frontal radiograph demonstrates extensive milk of calcium bile filling the gallbladder (GB) .
(Right) Specimen radiograph in the same patient after cholecystectomy demonstrates milk of calcium bile in both the GB and cystic duct .
(Left) Ultrasound shows diffuse low-level echo sludge within the GB lumen with posterior acoustic shadowing . Sludge and shadowing were not present on an ultrasound performed 6 months later.
(Right) Axial CECT shows high-density milk of calcium bile filling the GB lumen. The GB also demonstrates subtle wall calcification and a gallstone . There is a frequent association of gallstones and milk of calcium bile.
TERMINOLOGY
Synonyms
• Limy bile syndrome, calcium carbonate bile
Definitions
• High-density calcium carbonate precipitate within gallbladder (GB) lumen
IMAGING
General Features
• Best diagnostic clue
High-density layering liquid/sediment within GB
• Location
GB lumen
Radiographic Findings
• Radiography
Opacification of GB with high-density, radiopaque fluid
– Fluid-fluid level on upright film
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.
and cystic duct 
.
within the GB lumen with posterior acoustic shadowing 
. Sludge and shadowing were not present on an ultrasound performed 6 months later.
and a gallstone 
. There is a frequent association of gallstones and milk of calcium bile.
