Porcelain Gallbladder

General Considerations

• Calcification of all or part of the gallbladder wall
• So named because of its gross appearance (bluish in color) and its similarity to porcelain (brittle in consistency)
• Incidence:
• Less than 1% of cholecystectomy patients
• F:M  5:1
• Histology
• Flakes of dystrophic calcium within chronically inflamed and fibrotic muscular wall
• Wall is thickened and gallbladder is contracted
• Associated with gallstones in 90%
• Cystic duct is always obstructed
• 80% of patients with carcinoma of gallbladder have stones

Clinical Findings

• Patients are usually asymptomatic

Imaging Findings

• On conventional radiographs or CT, curvilinear calcifications in segment of the wall or entire wall
• CT is more sensitive than conventional radiographs
• Thickness of calcification may vary
• On ultrasound, highly echogenic, shadowing, curvilinear structure in GB fossa
• DDx: stone-filled contracted GB
• Echogenic GB wall with little acoustic shadowing
• DDx: emphysematous cholecystitis
• Scattered irregular clumps of echoes with posterior acoustic shadowing

Differential Diagnosis

• Imaging pitfall
• Contracted gallbladder with calcified wall can be mistaken for a gallstone
• Calcified hydatid cyst of liver
• Large gallstone with peripheral calcification

Treatment

• Because of its high association with carcinoma of the gallbladder, a cholecystectomy is usually performed

Prognosis

• 20-30% develop carcinoma of gallbladder

Porcelain Gallbladder. Upper: Radiograph of right upper quadrant of the abdomen shows a curvilinear calcification indicating calcification if the wall of a "hollow viscous" in the region of the gallbladder (white arrows). Lower: Axial CT image of the upper abdomen in the same patient confirms the thin calcification in the gallbladder wall (yellow arrows).
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Porcelain Gallbladder. eMedicine. AN Khan.