Ultrasound of Gallbladder Adenomyomatosis

What this episode covers

In this radiology lecture, we review the ultrasound appearance of adenomyomatosis of the gallbladder! Key teaching points include: * Common cause of benign gallbladder wall thickening seen in up to 9% of patients * Incidence increases with age * Usually asymptomatic, but may be associated with sporadic RUQ pain * Hyperplastic changes of gallbladder wall with mucosal overgrowth. Mucosal herniations protrude into muscular layer forming tiny, bile-filled cystic spaces = Rokitansky-Aschoff sinuses * If large, sinuses may appear as discrete cystic spaces in gallbladder wall * Cholesterol crystals in sinuses cause comet-tail reverberation artifact: Most common finding and highly specific for adenomyomatosis. Can exaggerate comet-tail with addition of color Doppler * Three types: Focal/fundal, segmental/annular and diffuse. Regardless of type, comet-tail artifacts and/or cystic spaces are key to diagnosis * Focal/fundal type: Most common. Often exhibits an “ovary on the gallbladder” appearance. Can be confused with a gallbladder mass. High-frequency linear transducer may be helpful to identify morphology * Segmental/annular type: Narrows waist of gallbladder yielding a figure 8 or hourglass configuration. Gallstones and/or sludge often form in proximal lumen due to increased stasis * If necessary, MRI helpful for problem solving: T2 hyperintense pearl necklace/string of beads appearance sensitive and specific To learn more about the Samsung RS85 Prestige ultrasound system, please visit: https://www.bostonimaging.com/rs85-prestige-ultrasound-system-4 Click the YouTube Community tab or follow on social media for bonus teaching material posted throughout the week! Spotify: https://spoti.fi/462r0F2 Instagram: https://www.instagram.com/Radquarters/ Facebook: https://www.facebook.com/Radquarters/ X (Twitter): https://twitter.com/Radquarters Reddit: https://www.reddit.com/user/radiologistHQ/

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