Porcelain gallbladder

Case contribution: Dr Radhiana Hassan


  • A 48 year old lady with no known medical illness
  • Presented with right flank to groin pain for 1 week and dysuria
  • Clinical examination shows abdomen soft and not tender
  • Blood investigation: Urea 2.3, creatinine 55. Uric acid 282.
KUB radiograph shows no calculus
Ultrasound KUB

Ultrasound findings:

  • Kidneys, ureter and urinary bladder are normal.
  • No calculus in the urinary tract
  • Gallbladder is partially distended. Hyperechoic lesion with posterior shadowing seen within the gallbladder and reported as big calculus.
CT scan in axial planes, non-contrast study in soft tissue window
CT scan in coronal and sagittal planes, non-contrast soft tissue window

CT scan findings:

  • Reverse liver (mean HU of 31) spleen (mean HU of 41) attenuation is observed in keeping with fatty liver changes.
  • No focal liver lesion is detected in this plain study.
  • The gallbladder is partially distended. The wall is slightly thickened. A rim calcification is seen outlining the inner wall of the gallbladder.
  • No pericholecystic streakiness or collection seen.
  • No urolithiasis.

Diagnosis: Incidental finding of porcelain gallbladder


  • Porcelain gallbladder is characterized by calcification of the gallbladder wall
  • It can be selective segmental mucosal calcification or complete intramural calcification with continuous band of calcium infiltrates.
  • It is rare, detected in 0.06 to 0.08 percent of cholecystectomy specimens.
  • There is female preponderance.
  • It is associated with chronic gallbladder inflammation.
  • About 95% of patients have associated gallstones.
  • Patients are usually asymptomatic and diagnosis is made incidentally on imaging.
  • There is associated increased in gallbladder cancer (adenocarcinoma-22%).
  • Cholecystectomy has been routinely performed when porcelain gallbladder is identified.
  • There is no accepted follow up interval but the annual incidence of developing gallbladder cancer is likely to be <1% per year and CT follow up is likely to be not helpful.
Author: radhianahassan