In this radiology lecture, we review the ultrasound appearance of adenomyomatosis of the gallbladder!

Key teaching points include:

Common cause of benign gallbladder wall thickening seen in up to 9% of patients
Incidence increases with age
Usually asymptomatic, but may be associated with sporadic RUQ pain
Hyperplastic changes of gallbladder wall with mucosal overgrowth. Mucosal herniations protrude into muscular layer forming tiny, bile-filled cystic spaces = Rokitansky-Aschoff sinuses
If large, sinuses may appear as discrete cystic spaces in gallbladder wall
Cholesterol crystals in sinuses cause comet-tail reverberation artifact: Most common finding and highly specific for adenomyomatosis. Can exaggerate comet-tail with addition of color Doppler
Three types: Focal/fundal, segmental/annular and diffuse. Regardless of type, comet-tail artifacts and/or cystic spaces are key to diagnosis
Focal/fundal type: Most common. Often exhibits an “ovary on the gallbladder” appearance. Can be confused with a gallbladder mass. High-frequency linear transducer may be helpful to identify morphology
Segmental/annular type: Narrows waist of gallbladder yielding a figure 8 or hourglass configuration. Gallstones and/or sludge often form in proximal lumen due to increased stasis
If necessary, MRI helpful for problem solving: T2 hyperintense pearl necklace/string of beads appearance sensitive and specific

To learn more about the Samsung RS85 Prestige ultrasound system, please visit: https://www.bostonimaging.com/rs85-prestige-ultrasound-system-4

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Ultrasound of Gallbladder Adenomyomatosis