Three patterns — a mass replacing the gallbladder, focal or diffuse wall thickening, an intraluminal polyp — then liver invasion, duct involvement and nodes; the hardest part is not calling xanthogranulomatous cholecystitis or adenomyomatosis cancer.
Orient first
- Risk factors: gallstones (large), porcelain gallbladder, polyps ≥ 10 mm (verify the current polyp guidance), anomalous pancreaticobiliary junction.
- Features favouring cancer: focal, asymmetric, irregular thickening with a disrupted mucosal line, direct liver invasion, and nodal disease.
- Adenomyomatosis shows Rokitansky–Aschoff sinuses (cystic spaces, comet-tail artefact) — a benign mimic.
Acquire the study
- Curvilinear and high-frequency linear probe over the fundus; fasted.
The manoeuvre
- Wall: focal or diffuse thickening in mm; is the inner mucosal line intact?
- Polyps: size in mm, sessile vs pedunculated, internal colour Doppler flow.
- Comet-tail reverberation in the wall = adenomyomatosis (benign).
- Adjacent liver: loss of the interface, a hypoechoic mass extending from the fossa.
What confirms it
- A mass or focal irregular wall thickening with liver invasion or nodal disease; histology confirms.
What licenses you to exclude it
- Diffuse, smooth, symmetric thickening with an intact mucosal line in a patient with cholecystitis, heart failure or hypoalbuminaemia favours a benign cause.
The classic misread
- Tumefactive sludge called a polyp — sludge moves with position change and has no flow.