“…As mentioned, his admission US was normal but once we obtained the repeat US and CT scan that showed hyperdense material in the gallbladder, we started entertaining additional etiologies of cholecystitis. Differential diagnosis of hyperdense material in the gallbladder includes extensive sludge, gallbladder polyposis, adenomyomatosis, and gallbladder carcinoma [ 10 ]. Our primary concern was gallbladder carcinoma, but since his preoperative US was normal and there were no signs of invasive disease on the CT scan, we thought this was less likely.…”