Presentation
Right upper quadrant pain.
Patient Data
The gallbladder appears divided into two compartments by a focal constriction.
Both gallbladder lumens show multiple small radiodense stones, yet the distal gallbladder lumen shows a thickened wall with subtle surrounding fat stranding.
Ultrasound of the gallbladder
Ultrasonography has more clearly showed a mid-focal mural thickening of gallbladder lumen, separating the distal gallbladder compartment from the proximal. In addition, the wall of distal gallbladder compartment appears thickened with multiple intraluminal echogenic stones.
MRCP study clearly identified the hourglass-gallbladder with multiple filling defects (intraluminal stones) noted in the distal portion of the gallbladder.
There is a focal mural thickening noted in the mid portions of the gallbladder with a tiny connection between the two lumens.
Low-lying cystic duct.
The CBD is not dilated, measuring about 0.4 cm, without a filling defect.
Case Discussion
The patient underwent cholecystectomy, and the specimen was sent for histopathology, which revealed two findings: chronic cholecystitis and adenomyomatosis.
Hourglass-gallbladder is the appearance observed in segmental-type of adenomyomatosis, which in this case was responsible for the focal mural thickening, and perhaps this constriction had led to stasis of the distal segment and subsequent development of isolated focal cholecystitis of the distal segment only.
Adenomyomatosis is an asymptomatic and benign condition that is classified into:
segmental or annular (such as in this case)
localized (in the fundus)
diffuse
Great attention should be given to differentiate it from gallbladder carcinoma.
Unable to process the form. Check for errors and try again.