Question:

All of the following are true in reference to Gallbladder adenomyomatosis except:
1. Results in diffuse epithelial and smooth muscle proliferation.
2. Likely the result of chronic gallbladder outlet obstruction.
3. Intramural diverticula contain bile, cholesterol, gallbladder sludge and/or gallstones.
4. Cholesterol crystals have characteristic ultrasound findings.
5. Dilated Rokitansky-Aschoff sinuses are best seen on T1 weighted sequences with the "Pearl necklace sign".





Answer:

The correct answer for the question "All of the following are true in reference to Gallbladder adenomyomatosis except:" is:

5. Dilated Rokitansky-Aschoff sinuses are best seen on T1 weighted sequences with the "Pearl necklace sign".



Explanation
a. Results in diffuse epithelial and smooth muscle proliferation.  [GBAM is a process of diffuse epithelial and smooth muscle proliferation likely in response to chronic GB obstruction.]

b. Likely the result of chronic gallbladder outlet obstruction.  [GBAM is a process of diffuse epithelial and smooth muscle proliferation likely in response to chronic GB obstruction.]

c. Intramural diverticula contain bile, cholesterol, gallbladder sludge and/or gallstones.  [Dilated Rokitansky-Aschoff (RA) sinuses contribute to formation of intramural diverticula that may contain bile, cholesterol, sludge, or stones.]

d. Cholesterol crystals have characteristic ultrasound findings.  [The cholesterol crystals demonstrate the characteristic reverberation or V-shaped comet tail artifact on ultrasound examination.]

e. Dilated Rokitansky-Aschoff sinuses are best seen on T1 weighted sequences with the "Pearl necklace sign".  [RA sinuses are also reported to be visible on T2 weighted MR; "Pearl necklace sign".]



From the manuscript:
Case report of xanthogranulomatous cholecystitis, review of its sonographic and magnetic resonance findings, and distinction from other gallbladder pathology
Radiology Case. 2011 Apr; 5(4):19-24


This article belongs to the GI section.




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From the manuscript

Case report of xanthogranulomatous cholecystitis, review of its sonographic and magnetic resonance findings, and distinction from other gallbladder pathology

Free full text article: Case report of xanthogranulomatous cholecystitis, review of its sonographic and magnetic resonance findings, and distinction from other gallbladder pathology

Abstract
A case of xanthogranulomatous cholecystitis is presented with a brief review of its sonographic and magnetic resonance features. These imaging features are also compared to those seen in gallbladder adenomyomatosis and gallbladder carcinoma. While there are many overlapping imaging findings in these entities, it is important to recognize distinguishing characteristics so a correct surgical approach is chosen. Laparoscopic cholecystectomy attempted with existing xanthogranulomatous cholecystitis has an increased surgical complication rate compared to open cholecystectomy and often necessitates intraoperative conversion to open cholecystectomy.






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