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PATHOLOGY OF THE GALLBLADDER AND BILIARY TREE 51
A
Figure 3.16 (A) The gallbladder lumen is filled with stones, causing dense shadowing in the gallbladder fossa. The
thickened gallbladder wall can be demonstrated separately (arrows) from the reflective surface of the stones.
(B) A small layer of bile is visible between the stones and the anterior gallbladder wall.
B
Figure 3.17
Microgallbladder in cystic fibrosis.
Figure 3.18 TS of a porcelain gallbladder
demonstrating a calcified wall with strong acoustic
shadowing.
HYPERPLASTIC CONDITIONS OF THE
GALLBLADDER WALL
Adenomyomatosis
This is a non-inflammatory, hyperplastic condition
which causes gallbladder wall thickening. It may be
mistaken for chronic cholecystitis on ultrasound.
The epithelium which lines the gallbladder wall
undergoes hyperplastic change, extending diverticula
into the adjacent muscular layer of the wall.
These diverticula, or sinuses (known as
Rokitansky–Aschoff sinuses), are visible within the
wall as fluid-filled spaces (Fig. 3.19), which can
bulge eccentrically into the lumen, and may contain
echogenic material or even (normally
pigment) stones.
The wall thickening may be focal or diffuse, and
the sinuses may be little more than hypoechoic