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.

Chronic gallbladder wall thickening: Is it always malignancy?

“…4 The hypothesis behind the pathogenesis of this condition is GB outflow or cystic duct obstruction by calculi, leading to a rupture of the Rokitansky-Aschoff sinuses, causing bile leakage into the wall of the GB. 5 Bile is then engulfed by macrophages and foamy histiocytes, resulting in a chronic granulomatous response, microabscess formation, subsequent wall fibrosis and scarring. This results in a high complication rate (up to 32%) 5 and includes GB perforation, adhesions, peritoneal scar formation and fistulous tracts to the stomach, duodenum, hepatic flexure or transverse colon and anterior abdominal wall.…”

“…5 Bile is then engulfed by macrophages and foamy histiocytes, resulting in a chronic granulomatous response, microabscess formation, subsequent wall fibrosis and scarring. This results in a high complication rate (up to 32%) 5 and includes GB perforation, adhesions, peritoneal scar formation and fistulous tracts to the stomach, duodenum, hepatic flexure or transverse colon and anterior abdominal wall. 5 Xanthogranulomatous cholecystitis presents clinically as chronic (88%) or acute cholecystitis (22%).…”

“…This results in a high complication rate (up to 32%) 5 and includes GB perforation, adhesions, peritoneal scar formation and fistulous tracts to the stomach, duodenum, hepatic flexure or transverse colon and anterior abdominal wall. 5 Xanthogranulomatous cholecystitis presents clinically as chronic (88%) or acute cholecystitis (22%). 1 Common clinical features include abdominal pain, obstructive jaundice or cholangitis.…”

“…The typical sonographic findings include diffuse, symmetrical, hyperechoic wall thickening, intramural hypoechoic nodules, associated cholelithiasis or choledocholithiasis. 5 On CECT, the wall thickening is always > 3mm and shows homogeneous enhancement 3 . Intramural hypoattenuating nodules are present in 85% of cases.…”

“…Both XGC and adenomyomatosis demonstrate wall thickening with sonographic hypoechoic intramural nodules and gallstones. 5 Rokitansky-Aschoff sinuses are also visualised on T2-weighted MRI as the 'Pearl necklace sign' and cholesterol crystals within them show comet-tail artefact. 5 Complications due to scar formation in XGC are typically absent in adenomyomatosis.…”