Teaching Case

Patient with intermittent right upper quadrant abdominal discomfort. Unremarkable clinical examination.

The patient presents with a history of intermittent right upper quadrant abdominal discomfort. The clinical examination is unremarkable. The patient is referred for a US exam of the upper abdomen.

Pathologically, gallbladder cholesterol polyps are a form of gallbladder cholesterolosis. Cholesterolosis is a condition where cholesterol is deposited within the lamina propria of the gallbladder. Although the cause is unknown, cholesterolosis does not appear to be related to serum lipid level, atherosclerosis, diabetes, cholesterol stones, or hypoconcentration of cholesterol in the bile. Cholesterol polyps are by far the most comon type of gallbladder polyp. There are usually multiple polyps, although it is not uncommon to detect only the largest one sonographically. Cholesterol polyps are usually less than 5 mm in size and only rarely get bigger than 10 mm. They can be distinguished from gallbladder stones by their lack of a shadow and nonmobile nature; and from sludge balls by their lack of mobility. Their small size and multiplicity help to distinguish them from true neoplasms of the gallbladder wall. Multiple polyps can also be seen in metastatic disease of the gallbladder wich is very uncommon.Melanoma has the greatest tendency to spread to the gallbladder, therefore detection of gallbladder polyps should be viewed with a high level of suspicion in patients with a history of melanoma. Generally there will be further evidence of metastatic disease in the liver, lymph nodes, or bowel in these patients. In general multiple gallbladder polyps are almost certainly cholesterol polyps and no further management is needed.