Abstract
We report our experience with 3 cases of gallbladder disease accompanied by hyperechoic nodules of the gallbladder wall in ultrasonographic images. All 3 patients complained of abdominal pain or back pain. Hyperechoic nodules were observed throughout the gallbladder wall in 2 patients, and a hyperechoic nodule was found in the body of the gallbladder of the third patient. Abdominal CT was performed in all 3 cases, and plain CT revealed high density nodules in 2 cases. MRI was performed in all cases, and in all of them, all of the hyperechoic nodules were high intensity in T1WI. The pathology in all cases was diagnosed as adenomyomatosis accompanied by chronic cholecystitis. Abscess was detected in fundus in one case, but it was unclear and poorly demarcated in the ultrasonic images. Demarcated hyperechoic nodules in the ultrasonographic images were thought to be Rokitansky-Aschoff sinus (RAS) with concentrated bile or sludge, or minute stones. An unclear hyperechoic nodule with an irregular margin was thought to be an abscess. We concluded that a hyperechoic nodule in gallbladder wall was RAS with inflammation. Xanthogranulomatous cholecystitis (XGC) is thought to result from rupture of the RAS, and almost all cases of XGC are accompanied by gallstones. But the cause of XGC when no gallstones are present is not known. The 3 cases reported here would appear to be a precursor stage of XGC.
