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Age: 77

Sex: Female

Indication: Right upper quadrant pain

Sonographic Murphy sign: Negative

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Case #45


  • Thickened, echogenic gallbladder wall with extensive corresponding posterior acoustic shadowing, which obscures much of the gallbladder
  • The visualized pericholecystic spaces show no definite fluid or inflammatory changes
  • Normal appearance of the liver and right kidney
  • Antegrade flow in the main portal vein
  • No biliary duct dilation
  • The visualized portion of the pancreas appears normal
  • The visualized portions of the abdominal aorta are normal in caliber


Porcelain gallbladder

Sample Report

Extensive mural calcification of the gallbladder (“porcelain gallbladder”), which is associated with an increased (but still low) risk for gallbladder adenocarcinoma. Although there are no specific findings for acute cholecystitis, the gallbladder is difficult to assess on this study and surgery consultation should be pursued if there are ongoing symptoms. If cholecystectomy is not performed, then followup surveillance imaging with contrast-enhanced CT or MRI is recommended in 6-12 months.

No additional findings to explain right upper quadrant pain.


  • Porcelain gallbladder was previously thought to confer a high risk for malignancy, but recent research suggests that although increased compared to the general population, this risk remains low (likely < 6%)
  • Many therefore suggest that following patients with porcelain gallbladder is appropriate, especially in older patients and patients with many comorbidities
  • Given poor visualization of the gallbladder due to the calcified rim on ultrasound, CT and MRI are more appropriate followup imaging modalities
  • There are two important mimics of porcelain gallbladder to consider:
    • Large calcified gallstone – If large enough, a gallstone can broadly contact the gallbladder wall, but the wall should still be visible separate from the stone (creating a wall-echo-shadow sign) unlike gallbladder wall calcification
    • Emphysematous cholecystitis – Gas generally results in ill-defined (“dirty”) shadowing whereas calcification results in sharp (“clean”) shadowing, but if ambiguous on ultrasound, CT can further evaluate


Thickened, echogenic gallbladder wall (red arrow) with sharp posterior acoustic shadowing (yellow arrows), which is a typical imaging appearance for porcelain gallbladder.

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