Adenomyomatosis of the Gallbladder: Diagnosis and Management

Imaging Characteristics

Adenomyomatosis is defined as mural hyperplasia that may be diffuse, focal, or segmental with characteristic imaging findings including comet-tail artifacts (on grayscale imaging) or twinkling artifacts (on color Doppler imaging) due to intramural cholesterol crystals, as reported in Radiology 1
Ultrasound is the initial imaging modality of choice, with characteristic findings including thickened gallbladder wall containing small cystic spaces (Rokitansky-Aschoff sinuses) and "comet-tail" artifacts on grayscale imaging 1
Advanced imaging options such as contrast-enhanced ultrasound (CEUS) can distinguish vascular lesions from sludge 2 3
MRI with cholangiography sequences shows characteristic "pearl-necklace sign" and has extremely high sensitivity for identifying Rokitansky-Aschoff sinuses 2

The Society of Radiologists in Ultrasound (SRU) consensus suggests that extended follow-up beyond 3 years is not productive for asymptomatic adenomyomatosis 2 3
Cholecystectomy is the recommended treatment for symptomatic adenomyomatosis of any type, with laparoscopic approach being the standard of care 2
Surgical risk is minimal with cholecystectomy, with morbidity of 2-8% 2 3
Risk of bile duct injury during cholecystectomy is approximately 0.3-0.6% 2 3
For pregnant patients with symptomatic adenomyomatosis, laparoscopic cholecystectomy is safe during pregnancy regardless of trimester, ideally performed in the second trimester 2