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case_images: (a) Ultrasound abdomen revealing a distended gallbladder filled with echogenic sludge (asterisk), (b) with asymmetrical wall thickening and intramural hypoechoic nodules (arrows).
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case_images: A pre-computed tomography (CT) ultrasound scan, performed at our institute, demonstrated a distended GB, filled with echogenic sludge (Figure 1a). Diffuse, asymmetrical, hyperechoic wall thickening was noted with two well-defined hypoechoic intramural nodules within the wall of GB (Figure 1).
case_images: (a) Nodules appear hypodense on contrast-enhanced computed tomography images (arrow). (b) Focal breach in mucosal lining (white arrow) and indistinctiveness with adjacent liver noted (black arrow).
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case_images: Contrast-enhanced computed tomography revealed homogeneous enhancement of the thickened GB wall with multiple intramural cystic areas (Figure 2a). Mucosal enhancement was relatively well preserved, except for a focal breach in the region of the body of the GB adjacent to the liver (Figure 2b); however, fat planes between the remaining organs were maintained.
case_images: (a and b) Axial T2W magnetic resonance imaging images demonstrating hyperintense intramural nodules (arrows), which on post-contrast T1W sequence (c) shows peripheral enhancement (black arrow), suggestive of a microabscess.
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case_images: Magnetic resonance imaging demonstrated a few intramural T2 hyperintense nodules within the wall of GB, confirming the diagnosis of XGC (Figure 3a-c). Although the adjacent liver had shown T2 hyperintense signal suggestive of oedema, post-contrast images indicated a maintained boundary between the enhanced GB wall and liver (Figure 3), suggesting inflammatory changes rather than invasion.
case_images: Fine needle aspiration cytology specimen from the fundus showing foamy macrophages (arrow) and polymorphs on May-Grunwald-Giemsa stain, consistent with the diagnosis of xanthogranulomatous cholecystitis.
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case_images: Histology showed polymorphs and foamy histiocytes, in keeping with XGC (Figure 4).