Definition
Calcium based incrustation of gallbladder wall.
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Radiographic Appearance
Plain abdominal image, the gall bladder is seen as having
a translucent but semi radiolucent appearance, often seen co
incidentally on IVU. and spine images
Non-functioning gallbladder on oral cholecystogram
Ultrasound highly echogenic shadowing curvilinear structure in the
gallbladder fossa (stone-filled contracted GB) echogenic
gallbladder wall with little acoustic shadowing (emphysematous
cholecystitis)
Scattered irregular clumps of echoes with posterior acoustic
shadowing
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Pathology
Extensive calcium encrustation of the gallbladder wall variably has
been termed calcified gallbladder, calcifying cholecystitis, or
cholecystopathia chronica calcarea. The term porcelain gallbladder
has been used to emphasize the blue discoloration and brittle
consistency of the gallbladder wall at surgery. Some authorities
amalgamate the terms and call all calcified gallbladders porcelain
gallbladders. The true incidence of porcelain gallbladder is
unknown, but it is reported to be 0.6-0.8%, with a male-to-female
ratio of 1:5. Most porcelain gallbladders (90%) are associated with
gallstones.
Patients are usually asymptomatic, and porcelain gallbladder is
found incidentally on plain abdominal radiographs, sonograms, or CT
images. Surgical treatment of porcelain gallbladder is based on
results from studies performed in 1931 and 1962, which revealed an
association between porcelain gallbladder and gallbladder carcinoma.
Porcelain gallbladder is uncommon, and recognizing the clinical and
imaging characteristics of the disease is important because of the
high frequency (22%) of adenocarcinoma in porcelain gallbladder.
Surgery should not be delayed, even if the patient is asymptomatic,
because the occurrence of carcinoma in porcelain gallbladder is
remarkably high.
Pathophysiology: Histologically, flakes of dystrophic calcium exist
within the chronically inflamed gallbladder wall. The muscular wall
of the gallbladder undergoes fibrotic changes. Microliths are
diffusely scattered throughout the mucosa, submucosa, and glandular
spaces and in the Rokitansky-Aschoff sinuses. Calcification occurs
in 2 forms: (1) a broad continuous band of calcification in the
muscularis and (2) multiple punctate calcifications in the mucosa
and glandular spaces of the mucosa. Gallstones are present in 90% of
patients, hydrops obstructs the cystic duct. Most authorities
consider gallbladder wall calcification to be secondary to a
low-grade inflammation, but intramural hemorrhage and an imbalance
in calcium metabolism also are implicated.
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Treatment:
Cholecystectomy recommended due to possibility of developing into a
carcinoma.
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Images of
Porcelain gall bladder
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Useful Link
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