PMC7276480_01
(a) Ultrasound abdomen revealing a distended gallbladder filled with echogenic sludge (asterisk), (b) with asymmetrical wall thickening and intramural hypoechoic nodules (arrows).
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A pre-computed tomography (CT) ultrasound scan, performed at our institute, demonstrated a distended GB, filled with echogenic sludge (Figure 1a). Diffuse, asymmetrical, hyperechoic wall thickening was noted with two well-defined hypoechoic intramural nodules within the wall of GB (Figure 1).
(a) Nodules appear hypodense on contrast-enhanced computed tomography images (arrow). (b) Focal breach in mucosal lining (white arrow) and indistinctiveness with adjacent liver noted (black arrow).
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Contrast-enhanced computed tomography revealed homogeneous enhancement of the thickened GB wall with multiple intramural cystic areas (Figure 2a). Mucosal enhancement was relatively well preserved, except for a focal breach in the region of the body of the GB adjacent to the liver (Figure 2b); however, fat planes between the remaining organs were maintained.
(a and b) Axial T2W magnetic resonance imaging images demonstrating hyperintense intramural nodules (arrows), which on post-contrast T1W sequence (c) shows peripheral enhancement (black arrow), suggestive of a microabscess.
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Magnetic resonance imaging demonstrated a few intramural T2 hyperintense nodules within the wall of GB, confirming the diagnosis of XGC (Figure 3a-c). Although the adjacent liver had shown T2 hyperintense signal suggestive of oedema, post-contrast images indicated a maintained boundary between the enhanced GB wall and liver (Figure 3), suggesting inflammatory changes rather than invasion.
Fine needle aspiration cytology specimen from the fundus showing foamy macrophages (arrow) and polymorphs on May-Grunwald-Giemsa stain, consistent with the diagnosis of xanthogranulomatous cholecystitis.
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Histology showed polymorphs and foamy histiocytes, in keeping with XGC (Figure 4).