Which biliary pathology is defined by herniation of the thickened gallbladder wall forming pockets (sinuses) where cholesterol crystals can collect?

Which biliary pathology is defined by herniation of the thickened gallbladder wall forming pockets (sinuses) where cholesterol crystals can collect?

• A. Rokitansky-Aschoff Sinuses
• B. Adenomyomatosis
• C. Biloma
• D. Pneumobilia

Answer: (A)

Rokitansky-Aschoff sinuses are mucosal outpouchings that extend into the muscular layer of the gallbladder wall. In adenomyomatosis, the gallbladder wall thickens and these intramural diverticula form, creating pockets where cholesterol crystals can accumulate. This intramural, crystal-containing sinus structure is the hallmark feature, and on ultrasound you may see echogenic foci within the thickened wall often with a comet-tail artifact from the cholesterol crystals in the sinuses. Biloma and pneumobilia describe fluid collection outside the biliary system and air within the biliary tree, respectively, not intramural sinuses.

Rokitansky-Aschoff sinuses are mucosal outpouchings that extend into the muscular layer of the gallbladder wall. In adenomyomatosis, the gallbladder wall thickens and these intramural diverticula form, creating pockets where cholesterol crystals can accumulate. This intramural, crystal-containing sinus structure is the hallmark feature, and on ultrasound you may see echogenic foci within the thickened wall often with a comet-tail artifact from the cholesterol crystals in the sinuses. Biloma and pneumobilia describe fluid collection outside the biliary system and air within the biliary tree, respectively, not intramural sinuses.