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Adenomyomatosis Imaging

Practice Essentials

Adenomyomatosis is a benign condition characterized by hyperplastic changes of unknown etiology involving the gallbladder wall and causing overgrowth of the mucosa, thickening of the muscular wall, and formation of intramural diverticula or sinus tracts termed Rokitansky-Aschoff sinuses. Adenomyomatosis is a common tumorlike lesion of the gallbladder with no malignant potential and may involve the gallbladder in a focal, segmental, or diffuse form. The focal type is the most common and usually involves the gallbladder fundus. Differentiating between adenomyomatosis and cholesterolosis is difficult at times. Hyperplastic cholecystosis is the term used to describe cholesterolosis and adenomyomatosis.

The etiology of cholesterolosis is also unknown. Cholesterolosis is a local phenomenon unrelated to atherosclerosis. Triglycerides and cholesterol esters are deposited in the lamina propria of the gallbladder wall. Grossly, the lipid deposits are visible, lending the gallbladder wall a strawberry-like appearance—hence, the term strawberry gallbladder. The deposits vary in size and can be as large as 1 cm.

Preferred examination

Ultrasonography (US) is the preferred radiologic examination. Oral cholecystogram can be used to diagnose adenomyomatosis; however, use of ultrasonography (US) and magnetic resonance imaging (MRI) is preferred. MRI, computed tomography (CT) scanning, and positron emission tomography (PET) can be used as problem-solving modalities, especially to differentiate hyperplastic cholecystosis from gallbladder carcinoma.

Occasionally, US cannot differentiate between the segmental type of adenomyomatosis and gallbladder carcinoma.

The imaging characteristics of adenomyomatosis are demonstrated in the images below.

Sonogram in a patient with adenomyomatosis.

Sonogram in a patient with adenomyomatosis.

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Oral cholecystogram shows focal fundal thickening

Oral cholecystogram shows focal fundal thickening in a patient with focal fundal adenomyomatosis.

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