Echogenic curvilinear structure in GB fossa with dense acoustic shadowing
– Clean posterior acoustic shadowing (no echogenic foci or “dirty” shadowing to suggest emphysema)
– Wall-echo-shadow complex not seen (unlike stones)
Biconvex curvilinear calcification of GB wall with visualization of posterior wall of GB
– Posterior GB wall not visualized with stones or emphysematous cholecystitis
Coarse foci of calcification in GB wall with acoustic shadowing
• CT
Calcifications in GB wall can be thin or thick and irregular
– May involve entire wall or just a segment
CT is most sensitive modality for identifying calcification
TOP DIFFERENTIAL DIAGNOSES
• Large gallstone or gallstones filling GB
• Emphysematous cholecystitis
• Iatrogenic high-density material in GB
CLINICAL ISSUES
• Most common in elderly female patients who are usually asymptomatic
• Traditionally thought to be associated with high risk of cancer, but recent studies suggest much weaker association (as low as 6%)
• Risk of GB cancer may depend on pattern of calcification, although evidence for this is limited
Diffuse intramural calcification: Likely no risk of cancer
Flecks of calcium in GB mucosa: ↑ risk of cancer
• Decision to operate depends on patient age, symptoms, morphology of calcification (diffuse vs. selective), and patient functional status
(Left) Transverse transabdominal ultrasound shows a curvilinear echogenic structure in the gallbladder (GB) fossa with acoustic shadowing , characteristic of a porcelain GB.
(Right) Ultrasound shows increased echogenicity throughout the GB wall and a mass within the fundus. The posterior GB wall is visible, unlike a GB filled with stones or emphysematous cholecystitis. Chronic cholecystitis, intramural calcification, and GB adenocarcinoma were identified at pathology.
(Left) Axial CECT shows partial calcification of the GB wall . Note the subtle soft tissue density within the GB and the blurred margin with the adjacent liver.
(Right) Axial CECT in the same patient demonstrates a discrete mass in the GB invading the liver, a classic appearance for GB cancer. GB cancer is thought to be more likely with interrupted, partial GB wall calcification than with diffuse calcification.
in the gallbladder (GB) fossa with acoustic shadowing 
, characteristic of a porcelain GB.
and a mass 
within the fundus. The posterior GB wall is visible, unlike a GB filled with stones or emphysematous cholecystitis. Chronic cholecystitis, intramural calcification, and GB adenocarcinoma were identified at pathology.
. Note the subtle soft tissue density 
within the GB and the blurred margin with the adjacent liver.
in the GB invading the liver, a classic appearance for GB cancer. GB cancer is thought to be more likely with interrupted, partial GB wall calcification than with diffuse calcification.
