Radiologic findings in xanthogranulomatous cholecystitis

Xanthogranulomatous cholecystitis is rare, and information on its radiologic diagnosis is limited. Radiologic findings of seven patients with histologically proven xanthogranulomatous cholecystitis were reviewed retrospectively. Sonography showed a calculus or calculi of the gallbladder with moderate thickening of the wall in all. IV cholangiography was performed in six cases. Findings were nonspecific. Four had nonopacified gallbladder, and one had stenosis of the proximal part of the common bile duct. Marked thickening of the gallbladder wall was seen in six of seven cases on CT. In one case the thickened wall was lobulated and irregular. The border between the gallbladder and the adjacent liver was unclear in two and relatively clear in five. Four patients underwent angiography to evaluate the possibility of tumor. Two of them had irregularity and stenosis of the cystic artery highly suggestive of carcinoma. The other two showed only dilatation of the cystic artery. On the basis of all radiologic studies, carcinoma was diagnosed preoperatively in two of the seven cases. Radiologically, xanthogranulomatous cholecystitis may best be regarded as a tumor-like condition and should be included in the differential diagnosis of gallbladder cancer.
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