From the Guidelines
Fundal adenomyomatosis of the gallbladder is generally a benign condition that doesn't require immediate treatment if you're not experiencing symptoms. This condition involves an overgrowth of the gallbladder muscle wall with outpouchings called Rokitansky-Aschoff sinuses, specifically located in the fundal (bottom) portion of your gallbladder. According to the Society of Radiologists in Ultrasound consensus conference recommendations 1, adenomyomatosis is characterized by mural hyperplasia that may be diffuse, focal, or segmental with comet-tail artifact or twinkling artifact due to intramural cholesterol crystals.
If you're asymptomatic, regular monitoring with ultrasound every 6-12 months is typically recommended to ensure the condition doesn't progress, as the risk of malignant transformation is very small 1. However, if you're experiencing symptoms like right upper quadrant pain, nausea, or digestive issues after fatty meals, treatment options include pain management with NSAIDs like ibuprofen (400-600mg every 6-8 hours as needed) and dietary modifications to reduce fat intake.
In cases of persistent symptoms or if the adenomyomatosis is extensive, surgical removal of the gallbladder (cholecystectomy) may be recommended. The condition itself carries a very small risk of malignant transformation, which is why monitoring is important. Adenomyomatosis is thought to develop from increased pressure within the gallbladder, possibly related to bile flow obstruction, and is found in approximately 2-5% of all gallbladders examined. It's essential to note that the management of incidentally detected gallbladder polyps, as discussed in the SRU consensus conference recommendations 1, may not directly apply to adenomyomatosis, but the principles of monitoring and treatment can be similar.
Key points to consider:
- Regular monitoring with ultrasound every 6-12 months for asymptomatic patients
- Pain management with NSAIDs and dietary modifications for symptomatic patients
- Surgical removal of the gallbladder (cholecystectomy) for persistent symptoms or extensive adenomyomatosis
- Very small risk of malignant transformation, emphasizing the importance of monitoring 1
From the Research
Ultrasound Findings
- The ultrasound showed fundal adenomyomatosis of the gallbladder, which is a benign acquired gallbladder disease 2, 3.
- Adenomyomatosis can mimic cancer on radiological findings, leading to a diagnostic dilemma 2.
- The disease is characterized by hypertrophy of the mucosal epithelium that invaginates into the interstices of a thickened muscularis, forming Rokitansky-Aschoff sinuses 3.
Diagnosis and Management
- High-resolution ultrasound is the most efficient radiological examination for diagnosing gallbladder adenomyomatosis 2.
- The diagnosis can be confirmed by histologic examination when cholecystectomy is done 2.
- Laparoscopic cholecystectomy is the gold standard for symptomatic adenomyomatosis or radiological suspicion of gallbladder cancer 2.
- Asymptomatic adenomyomatosis is not an indication for surgery, but the radiological diagnosis must be beyond any doubt 3.
Types of Adenomyomatosis
- There are three forms of adenomyomatosis: segmental, fundal, and diffuse 3.
- The fundal form is more common, and the segmental form has a higher risk of malignancy 4.
- The localized fundal type of adenomyomatosis can be difficult to differentiate from gallbladder cancer using ultrasonography alone 5.
Imaging Modalities
- Contrast-enhanced ultrasonography (CEUS) can increase the degree of visualization of Rokitansky-Aschoff sinuses and intactness of the gallbladder wall, which plays an important role in differential diagnosis 5.
- MRI with MRI cholangiography sequences is the reference examination with characteristic "pearl necklace" images 3.
- CT or MRI can be effective in attempting to differentiate a benign or malignant cholecystic mass if ultrasound is not diagnostic 6.