Porcelain Gallbladder

Published on 19/07/2015 by admin

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Last modified 19/07/2015

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 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)
image Biconvex curvilinear calcification of GB wall with visualization of posterior wall of GB

– Posterior GB wall not visualized with stones or emphysematous cholecystitis
image Coarse foci of calcification in GB wall with acoustic shadowing
• CT

image Calcifications in GB wall can be thin or thick and irregular

– May involve entire wall or just a segment
image 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

image Diffuse intramural calcification: Likely no risk of cancer
image 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
image
(Left) Transverse transabdominal ultrasound shows a curvilinear echogenic structure image in the gallbladder (GB) fossa with acoustic shadowing image, characteristic of a porcelain GB.

image
(Right) Ultrasound shows increased echogenicity throughout the GB wall image and a mass image 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.
image
(Left) Axial CECT shows partial calcification of the GB wall image. Note the subtle soft tissue density image within the GB and the blurred margin with the adjacent liver.

image
(Right) Axial CECT in the same patient demonstrates a discrete mass image 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.

TERMINOLOGY

Synonyms

• Calcified gallbladder (GB), calcifying cholecystitis

Definitions

• Calcification of GB wall

IMAGING

General Features

• Best diagnostic clue

image Curvilinear rim of calcification in right upper quadrant (RUQ) conforming to shape of GB
• Morphology

image 2 patterns

– Selective mucosal calcification: ↑ risk of malignancy
– Diffuse intramural calcification: ↓ risk of malignancy

Radiographic Findings

• Radiography

image Curvilinear or granular calcification in GB wall
image May involve entire wall or just a segment

Fluoroscopic Findings

• Usually nonfunctional GB on oral cholecystograms

CT Findings

• Calcification in GB wall can be thin or thick and irregular

image May involve entire wall or just a segment
• CT is most sensitive modality for identifying calcification

Ultrasonographic Findings

• 

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