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Clinical Images  |   January 2016
Incidental Adenomyomatosis of Gallbladder With Renal Cell Carcinoma
Author Notes
  • From the Department of Radiology at Stony Brook University Hospital in New York (Dr Madu) and the Department of Radiology at the Brookhaven Memorial Hospital Medical Center in Patchogue, New York (Dr Weltman). 
  •  *Address correspondence to Ezemonye Madu, DO, MPH, Stony Brook University Hospital, 101 Nicolls Rd, Suite 120, Stony Brook, NY 11794-0001. E-mail: emadu4@gmail.com
     
Article Information
Imaging / Hypertension/Kidney Disease / Obstetrics and Gynecology / Urological Disorders / Clinical Images
Clinical Images   |   January 2016
Incidental Adenomyomatosis of Gallbladder With Renal Cell Carcinoma
The Journal of the American Osteopathic Association, January 2016, Vol. 116, 62. doi:10.7556/jaoa.2016.016
The Journal of the American Osteopathic Association, January 2016, Vol. 116, 62. doi:10.7556/jaoa.2016.016
A 58-year-old man with a history of renal cell carcinoma and hypertension presented to the emergency department with shortness of breath and abdominal pain. On examination, his heart rate was 99/min, respiration rate was 24/min, and oxygen saturation while breathing room air was 90%. He had abdominal distension and bilateral pitting edema of the leg. An abdominal ultrasonogram showed heterogeneous shrunken liver, ascites, and mildly distended gallbladder containing sludge, with echogenic foci showing comet-tail artifacts from a sagittal view (image A, arrow) and a transverse view (image B, arrow). These features are consistent with adenomyomatosis. The patient was treated for acute respiratory distress, ascites, and other comorbidities associated with stage IV renal cell carcinoma. A week after admission, the patient’s acute symptoms resolved and he was discharged to subacute rehabilitation with outpatient follow-up. 
Adenomyomatosis of the gallbladder is a common hyperplastic cholesterolosis. It arises from gallbladder tissue proliferation, wall thickening, and mucosal out-pouches.1-3 Cholesterol within these out-pouches was responsible for the echogenic foci with comet-tail artifacts. Although gallbladder adenomyomatosis is usually not clinically significant, physicians should be aware of gallbladder adenomyomatosis to avoid unnecessary cholecystectomies, which may occur if the condition is misdiagnosed as emphysematous cholecystitis, cholelithiasis, or gallbladder carcinoma.2,3 
References
Haradome H, Ichikawa T, Sou H, et al. The pearl necklace sign: an imaging sign of adenomyomatosis of the gallbladder at MR cholangiopancreatograph. Radiology. 2003; 277(1): 80-88. doi:10.1148/radiol.2271011378. [CrossRef]
Bang SH, Lee JY, Woo H, et al. Differentiating between adenomyomatosis and gallbladder cancer: revisiting a comparative study of high-resolution ultrasound, multidetector CT and MR imaging. Korean J Radiol. 2014; 15(2): 226-234. doi:10.3348/kjr.2014.15.2.226. [CrossRef] [PubMed]
Eid M, Abdelgawad MS, El-Sirafy M. Role of multidetector CT (MDCT) in differentiation between adenomyomatosis and gallbladder cancer. Egypt J Radiol Nucl Med. 2012; 43(1): 93-97. doi:10.1016/j.ejrnm.2011.12.007. [CrossRef]