RADQUIZ -MARZO - SOLUTION

XANTHOGRANULOMATOUS CHOLECYSTITIS
Authors: Danilo Sirigu MD; Pietro Iannelli MD; Graziella Farci MD.
A.O.Brotzu, Cagliari

Video US
Transabdominal ultrasound with a 4 Mhz convex shows an intraluminal echogenic material due to sludge and gallstones. Gallbladder wall is markedly tickened and contains hypoechoic nodules.

Video Us2
Transabdominal ultrasound with a 10 Mhz linear probe shows a gallbladder wall is markedly tickened and contains hypoechoic nodules.

VIDEO CT- CECT
Assial CT and Contrast-enhanced CT scans shows deformed and thickened gallbladder wall and hypoattenuating mural nodes and intraluminal stones.

HISTOLOGY VIDEO
Infiltration into the wall of the gallbladder with foamy cells (lipid laden histiocytes), multinucleated giant cells and inflammatory cells.

CLINICAL CASE

A 59 year old male presented with acute abdominal pain located in the epigastric and right hypochondriac region , nausea , vomiting and fever.

The patient was a history of repeated episodes of biliary colic .

There was no history of jaundice.

The physical examination revealed positive Murphy sign.

Clinical profile: Increased with blood cell (WBC count was 20.000 ) and other blood investigations were within normal limits .

DISCUSSION:

Xanthogranulomatous cholecystitis (CX) is an unusual variant of chronic cholecystitis , characterized by the presence of chronic, inflammatory infiltration, formation of granulomas, with fibrosis and severe histiocytic reaction with macrophages rich in foam cells

Although well defined pathologically, xanthogranulomatous cholecystitis still remains difficult for the radiologist to recognize because some of the sonographic and CT features of the disease are nonspecific, such as gallbladder wall thickening and calculi.

Imaging studies show marked gallbladder wall thickening, with the wall often containing nodules that are hypoechoic at sonography and hypoattenuating at CT ; these nodules are abscesses or foci of xanthogranulomatous inflammation.

Its importance lies in the fact that clinically and radiologically it can be confused with the prognostically far more serious condition of carcinoma of the gallbladder.

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