Xanthogranulomatous cholecystitis: Clinical, sonographic, and CT findings in 26 patients

OBJECTIVE. The purpose of our study was to evaluate the sonographic and CT features of xanthogranulomatous cholecystitis, correlating the pathologic a nd surgical findings. MATERIALS AND METHODS. Xanthogranulomatous cholecystitis was pathologically diagnosed in 26 patients from January 1996 to August 1998. The patients we re 15 women and 11 men with a mean age of 63 years. All patients had preope rative sonography and nine also underwent CT. In five patients, sonography was performed on the surgical specimen. Clinical indications for imaging in cluded cholecystitis (14 patients), biliary colic (six patients), stone-ind uced pancreatitis (three patients), tumor (two patients). and gallstone ile us (one patient). RESULTS. The most characteristic sonographic finding, confirmed by sonograp hic study of the surgical specimens, was the presence of hypoechoic nodules or bands in the gallbladder wall, which were seen in 35% of the patients. Cholelithiasis and a thickened gallbladder wall were frequent findings. The most characteristic (specific) CT finding was a hypodense band in the gall bladder wall, seen in 33% of the patients. Two of twelve patients who under went laparoscopic cholecystectomy required conversion to open surgery. CONCLUSION. Although the preoperative imaging diagnosis of xanthogranulomat ous cholecystitis is difficult, the presence of hypoechoic nodules or bands in the gallbladder wall on sonography or of a hypodense band around the ga llbladder on CT, is highly suggestive of this disease.