An 80-years-female patient came with history of dull pain in right upper quadrant for two months. Computed Tomography upper abdomen and sonography was done.
Scanogram abdomen showed well-defined globular coarse calcification of gall bladder wall in right hypochondrium with an oval calcified area adjacent to it suggestive of GB calculus (Fig. 1).
Computed Tomography upper abdomen showed well defined coarse circumferential calcification of wall of gall bladder. A partially calcified calculus was seen in the neck of GB (Fig. 2a, b)
Sonography of gall bladder shows well defined crescent shaped calcification of wall of GB with distal acoustic shadowing. No intraluminal calculus visualised due to dense distal acoustic shadowing (Fig. 3).
The term “porcelain gallbladder” was coined in 1929 to describe the brittle consistency of a gallbladder with an extensively calcified wall. Porcelain derives its name from a ceramic material made by heating raw materials, generally including clay in the form of kaolin at very high temperatures.
Porcelain gallbladder is an uncommon manifestation of chronic cholecystitis characterised by intramural calcification of the gallbladder wall. The incidence of a calcified gallbladder ranges from 0.06 to 0.08%. It is more common in females than in males with a ratio of 5:1 . The mean age at presentation varies from 38 to 70 years. Most patients are diagnosed as an incidental finding on imaging, although 90% of cases are associated with gallstones. 
Patients with a porcelain gallbladder are often asymptomatic but may complain of dull pain in the abdomen. They are at increased risk for the development of gallbladder carcinoma with incidence of gallbladder carcinoma ranges from 7 to 33% .
Sonographically the calcified wall can easily be detected. It is characterised by intramural shell-like calcification that may affect the entire wall or parts of it. Computed Tomography confirms the presence of calcification of the gallbladder wall .
The differential diagnosis of porcelain gall bladder is from single large intraluminal GB calculus, the former shows wall calcification however gall bladder wall can be differentiated from the calculus due to presence of minimal intraluminal bile .
Treatment for patients with a porcelain gallbladder requires open cholecystectomy because of its association with gallbladder carcinoma [4, 5].
Porcelain GB is a rare condition associated with high incidence of carcinoma formation. Imaging with radiological diagnostic modalities helps clinician in early resection of the GB to save patient from the risk of developing malignancy.
Differential Diagnosis List
Porcelain gall bladder
Global adenomyomatosis GB