Sonography of adenomyomatosis of the gallbladder: radiologic-pathologic correlation.

Abstract

Sonograms of six patients with adenomyomatosis of the gallbladder were reviewed and correlated with oral cholecystographic and pathologic findings. The gallbladder was visualized in four of the six patients by oral cholecystography, which also revealed intramural diverticula. Five of the six patients showed sonographic evidence of diffuse or segmental thickening of the gallbladder wall and intramural diverticula, seen as anechoic or echogenic foci within the wall. Intramural diverticula containing bile appeared as anechoic spaces; those containing biliary sludge or gallstones appeared as echogenic foci with or without acoustic shadows or reverberation artifacts. There was good correlation between sonographic and pathologic findings in three patients. The authors conclude that adenomyomatosis of the gallbladder should be suspected when (a) there is diffuse or segmental thickening of the gallbladder wall and (b) intramural diverticula are seen as anechoic or echogenic foci with or without associated acoustic shadows or reverberation artifacts.

Evaluation of gallbladder and biliary duct disease using microbubble contrast-enhanced ultrasound

“…The US appearance of an intramural diverticulum depends on its composition; it is anechoic when only bile is present and echogenic if it contains cholesterol or stones. The characteristic feature is the V-shaped "comet tail" reverberation artefact seen emanating from the small echogenic foci in the gallbladder wall [11]. The enhancing gallbladder wall is better visualised following microbubble contrast administration, which aids the depiction of the non-enhancing intramural diverteculum and thus facilitates correct diagnosis (Figure 3).…”

Differential diagnosis of gallbladder cancer using positron emission tomography with fluorine‐18‐labeled fluoro‐deoxyglucose (FDG‐PET)

“…Adenomyomatosis of the gallbladder is a common disease that usually presents as a focal lesion or as a diffuse wall thickening of the gallbladder, and therefore differentiating it from gallbladder carcinoma is important [24]. The value of the Rokitansky-Aschoff sinuses in the diagnosis of adenomyomatosis has been suggested on transabdominal sonography, CT, and MR imaging [25][26][27]. However, with these conventional imaging modalities, the differential diagnosis from gallbladder carcinoma is often difficult to make.…”

Combined segmental and focal adenomyomatosis involving the body of the gallbladder

“…Pathologically, adenomyomatosis is defined as epithelial proliferation, hypertrophy, and thickening of the muscularis layer where the mucosa outpouches into the thickened wall, forming anechoic intramural diverticula known as Rokitansky-Aschoff sinuses. 1,3,4 On cut sections they appear as dilated cystic spaces in the thickened bladder wall. The Rokitansky-Aschoff sinuses are known to be pathognomonic structures for the diagnosis of adenomyomatosis.…”