Porcelain gallbladder
Updates to Article Attributes
Porcelain gallbladder refers to extensive calcium encrustation of the gallbladder wall. The term has been used to emphasise the blue discolouration and brittle consistency of the gallbladder wall at surgery but is often an incidental finding on multiple different imaging modalities.
Clinical presentation
Patients are usually asymptomatic, and porcelain gallbladder is usually found incidentally on plain abdominal radiographs, ultrasound, or CT images.
Radiographic features
Ultrasound
On ultrasound, the gallbladder demonstrates echoes and posterior dense shadowing, with usually poor delineation of the gallbladder wall itself. This could be mistaken for gas in the gallbladder wall (emphysematous cholecystitis).
Plain radiograph and CT
The appearance of porcelain gallbladder on both radiography and CT are pathognomonic, demonstrating a thin layer of mineralisation outlining the gallbladder wall.
MRI
Because of MRI's inferior ability to detect calcification, relative to CT, it does not play a significant role in imaging the condition.
Treatment and prognosis
Based on early studies which revealed a high association between porcelain gallbladder and gallbladder adenocarcinoma (22-30% of porcelain gallbladders developing gallbladder adenocarcinoma 3), cholecystectomy has been routinely performed when a porcelain gallbladder is identified.
More recent studies have cast some doubt on the association, and the risk of gallbladder cancer associated with calcification of the wall may be as low as 5-7% 1,4.
There is no accepted follow-up interval, but the annual incidence of developing gallbladder cancer is likely to be <1% per year, and CT follow-up is likely to be unhelpful 4.
Differential diagnosis
On ultrasound, also consider:
- gallstones / wall-echo-shadow sign: there should be a thin hypoechoic bile space between the gallbladder "wall" and the gallstone "echo"
- gas: shadowing of air tends to be dirty, rather than the clean anechoic shadow of calcification
- emphysematous cholecystitis
- pneumobilia
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Adjacentadjacent bowel is mistaken for gallbladder
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