2025 Volume 74 Issue 1 Pages 133-139
A woman in her 60s presented with the chief complaints of fever and right hypochondriac pain. Ultrasonography (US) showed an enlarged gallbladder and circumferential wall thickening with laminar structures, and CT showed circumferential wall thickening with dilatation of the Rokitansky-Ashoff sinus. She was diagnosed with xanthogranulomatous cholecystitis (XGC). The patient’s condition was relieved with antibiotic treatment. However, 27 days after onset, US showed a progression of the gallbladder wall. The wall was irregular with a loss of layering, but the innermost hyperechoic layer (IHL) was continuous. The wall was hyperechogenic with a hypoechoic area inside the wall. CT showed inflammation spreading to the hepatic be. We therefore suspected an exacerbation of XGC, but advanced gallbladder cancer was also suspected. The diagnosis of XGC was further confirmed by the finding of hypoechoic areas inside the wall and continuity of IHL, as well as an improvement in gallbladder wall thickening. Laparoscopic cholecystectomy was performed 98 days after onset, and the pathological diagnosis was XGC. The course of US findings suggested that the patient was in the transition stage from acute cholecystitis to XGC when he first visited our hospital, and that xanthogranuloma had formed on day 27 of onset. When observing the course of XGC with US, differentiate it from gallbladder cancer by focusing on changes in the gallbladder wall structure and continuity of IHL, and also it is necessary to carefully observe the entire gallbladder, keeping in mind the possibility that gallbladder cancer may exist in areas other than XGC.
