Imaging Sciences Interesting Cases
Case 182
Sam McCabe, MD
Clinical Presentation: A 51-year-old asymptomatic male presented for further evaluation of unrelated CT finding.
Imaging Findings: Multiple small gallbladder polyps with "comet-tail" artifacts
 |
| Figure 1: Transverse US image through the gallbladder demonstrates numerous hyperechoic foci in the gallbladder wall. All demonstrate the "comet tail" artifact. |
Diagnosis: Hyperplastic cholecystosis
Discussion: "Hyperplastic cholecystoses" is the collective term for two forms of benign, idiopathic gallbladder wall cholesterol deposition: cholesterolosis and adenomyomatosis. Both demonstrate the "comet tail" artifact by ultrasound, which is pathognomonic. The comet tail artifact is a type of reverberation artifact which results from sound wave reverberation in cholecterol crystals. Gallbladder cholesterolosis results from the deposition of cholesterol-laden histiocytes in the gallbladder submucosa. The term "strawberry gallbladder" has been used to describe the gross appearance of these numerous small deposits. Adenomyomatosis consists of diffuse or focal gallbladder mucosal hypertrophy with exaggeration of the normal luminal folds. Cholesterol crystals deposited in these folds (Rokitansky Aschoff sinuses) produce the comet tail artifact. Adenomyomatosis may have gallbladder wall thickening with hypoattenuation within the thickened portion, reflecting R-A sinuses large enough to be resolved by US.
Both hyperplastic cholecystoses are most often asymptomatic incidental findings, most commonly in middle aged women. No associated risk of cholecystitis or gallbladder carcinoma has been found. There is also no association with hypercholesterolemia or gallstones. No treatment is necessary unless the patient is symptomatic, in which case cholecystectomy is performed.
References:
- Kurtz AB, Middleton WD. Ultrasound: The Requisites. Mosby, 1996.
- Dogra V, Rubens DJ (eds). Ultrasound Secrets. Philadelphia, PA: Hanley and Belfus; 2004.