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Incidental Adenomyomatosis of Gallbladder With Renal Cell Carcinoma

  • Ezemonye Madu and David Weltman
Published/Copyright: January 1, 2016
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Journal of Osteopathic Medicine
From the journal Journal of Osteopathic Medicine Volume 116 Issue 1

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

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:

References

1. Haradome H ,IchikawaT,SouH,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.2271011378.10.1148/radiol.2271011378Search in Google Scholar PubMed

2. Bang SH ,LeeJY,WooH,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.2014.15.2.226.10.3348/kjr.2014.15.2.226Search in Google Scholar PubMed PubMed Central

3. Eid M ,AbdelgawadMS,El-SirafyM. 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.2011.12.007.10.1016/j.ejrnm.2011.12.007Search in Google Scholar
Accepted: 2015-06-01
Published Online: 2016-01-01
Published in Print: 2016-01-01

© 2016 American Osteopathic Association

This work is licensed under the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.

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https://doi.org/10.7556/jaoa.2016.016
Creative Commons
BY-NC-ND 4.0

Articles in the same Issue

  1. SURF
  2. Determining the Feasibility of Managing Erectile Dysfunction in Humans With Placental-Derived Stem Cells
  3. Modern Still Life
  4. ORIGINAL CONTRIBUTION
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  9. Gamification and Multimedia for Medical Education: A Landscape Review
  10. Linking Community Hospital Initiatives With Osteopathic Medical Students’ Quality Improvement Training: A Pilot Program
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  16. Myofascial Trigger Point Release Massage Therapy Relieves Tension-Type Headaches
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  24. Incidental Adenomyomatosis of Gallbladder With Renal Cell Carcinoma
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