Fact-sheet: Adenomyomatosis of gallbladder
Updated on 03/28/2019 at 9:37 AM
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Definition
Non-inflammatory and non-tumoral thickening of the gallbladder.
Acquired condition.
Wall hyperplasia, with mucosal invagination creating Rokitansky-Aschoff sinuses
Clinical features
Incidental finding.
No sex predominance.
Incidence 2 to 5%.
Associated in more than 50% of cases with gallstone disease (which may be symptomatic)
Laboratory findings
Normal
Ultrasound
Location: diffuse / focal (most often gallbladder fundus, or another segment).
- Segmental or diffuse wall thickening.
- Small anechoic foci (dilated Rokitansky-Aschoff sinuses).
- Reverberation artifacts (or comet-tail artifacts) from US trapping in the dilated sinus. (highly specific++).
- +/- Associated gallstone disease.
- Negative sign for acute cholecystitis: no gallbladder hydrops.
CT
- Segmental or diffuse wall thickening.
- Interpretation according to clinical findings ++
- Presence of cysts within the thickening (specific but not sensitive)
- Small calcifications within the thickening (calculi developed within the R-A sinuses)
- Marked mucosal enhancement at the arterial phase
MRI
- Multiple fluid collections within the thickened gallbladder wall. (gallbladder described as a "string of pearls" appearance in the generalized form, "hourglass" appearance in the segmental form).
- Diagnostic sensitivity: MRI > US > CT
Nuclear medicine
Possibly hypermetabolic on 18F-FDG PET (due to local inflammation).
Management
No follow-up
No treatment
Resection if symptomatic (associated symptomatic gallstone disease)
Differential diagnosis
Acute/chronic cholecystitis
All other causes of gallbladder wall thickening
Gallbladder carcinoma