Figure of 8 Gallbladder with a Focal Fundal Thickening

Clinical History

A 56-year old lady presented with an acute onset of epigastric tenderness and pain radiating to the right upper abdominal quadrant. Ultrasound of the abdomen was requested for an initial assessment.

Case Description

Ultrasound revealed a ‘figure of 8’ gallbladder morphology with mild focal thickening at the fundal half (focal fundal thickening). There were also two tiny flecks of interstitial gas pockets within the gallbladder wall that appeared as reverberation artefacts and twinkling on colour Doppler imaging.

Diagnosis/ Discussion/ Treatment/ Follow up

The patient had magnetic resonance cholangiopancreaticography (MRCP) which further confirmed the ultrasound findings of adenomyomatosis.

Gallbladder adenomyomatosis is a benign condition in which there is hypertrophy of the gallbladder mucosal epithelium with an invagination into its interstices. This leads to the formation of gas pockets within the gallbladder wall known as Rokitansky-Aschoff sinuses.