1. DDx :

Gallbladder carcinoma

Chronic colecystitis

Phrygian cap

2. KEY POINTS :

Adenomyomatosis describes an acquired, hyperplastic lesion of the gallbladder characterized by proliferation of surface epithelium with invaginations into a thickened muscularis propria.
Ultrasonography may reveal a thickened gallbladder wall with intramural diverticula which is called Rocitansky-Aschoff sinuses.
Adenomyomatosis can cause diffuse, segmental fundal gallbladder wall involvement.
Pearl necklace sign is typical finding on MR MRCP in diffuse adenomyomatosis.
Adenomyomatosis may portend a higher risk of gallbladder malignancy.
Adenomyomatosis is found in 1-8.7% of cholecystectomy specimens.
Most of the patients remain asymptomatic and dont need treatment. When it causes right upper quadrant pain and fever, the treatment is cholecystectomy.

References :

1. Sermon A, Himpens J, and Leman G, Symptomatic adenomyomatosis of the gallbladder--report of a case. Acta Chir Belg, 2003. 103(2): p. 225-9.

2. Ching BH, Yeh BM, Westphalen AC, Joe BN, Qayyum A, and Coakley FV, CT differentiation of adenomyomatosis and gallbladder cancer. AJR Am J Roentgenol, 2007. 189(1): p. 62-6.

3. Owen CC and Bilhartz LE, Gallbladder polyps, cholesterolosis, adenomyomatosis, and acute acalculous cholecystitis. Semin Gastrointest Dis, 2003. 14(4): p. 178-88.

Case

Contributed by :	abdomenrad	TEACHING POINTS click here Patient Data : Age : 67 - Gender : Female
Diagnosis :
Adenomyomatosis
Findings :
On T2 axial images, the fundus of gall bladder has multiple small cysts with focal wall thickening and enhances on postcontrast images. On T1WI; intraluminal milimetric calculi are seen. A hemangioma which is homogeneous hyperintense on T2WI and shows peripheral nodular enhancement on postcontrast series at segment 7 is observed. Also hiatal sliding hernia of stomach is present.
History :
A patient with history of cholelitiasis presented to the hospital. Abdominal ultrasound was performed. After examination, wall thickening of gall bladder and multiple intraluminal milimetric calculi were noted.

1- axial T2 Fatsat 2- Precontrast T1Fsat 3- Portal venous phase ↑ ↓