Adenomyomatosis of the gallbladder in a 28-year-old white female. Note the characteristic segmentation of the small narrow gallbladder with hyperconcentration of the contrast media (Image 1). There is contrast within numerous Rokitansky-Aschoff sinuses, representing intramural diverticulosis of the gallbladder which is one of the components of adenomyomatosis. Constriction of the tip of the fundus as well as the proximal portion of the gallbladder is also noted. All of these findings are accentuated following a fatty meal ingestion (Image 2), where the gallbladder becomes even denser and smaller with hypercontraction and increased intramural contrast present (Image 3). This young woman had severe right upper quadrant pain and had a previous ultrasound examination of the gallbladder interpreted as normal 3 days earlier. At the age of 15 she experienced similar pain and was also told an ultrasound exam at that time was normal. Oral cholecystography may be superior to ultrasound in some patients in establishing the diagnosis of adenomyomatosis or hyperplastic cholecystosis and also in many cases of acalculous cholecystitis, where sonography may be normal or present borderline findings difficult to interpret.

Image 1 Image 2 Image 3