This was a 38 year old man who on a annual check up was found to have some abnormality in the gall bladder . He was asymptomatic, but on repeated questioning gave history of indigestion on taking oily food.His family physician advised him to repeat ultrasound after a year.

His ultrasound now revealed the following findings :

multiple echodensities seen in the gallbladder

all the echodensities are seen attached to the gallbladder wall

this clearly shows the echodensities attached to the GB wall

high definition live reconstruction of the same finding

high definition live reconstruction shows the echodensities in the posterior wall of the gallbladder

3 d reconstruction

The following text is based on the sonoworld article http://www.sonoworld.com/ArticleDetails/Cholesterolosis_of_the_gall_bladder.aspx?ModuleCategoryId=163

Cholesterolosis is a part of the spectrum of degenerative and proliferative changes seen in the gall bladder, termed as hyperplastic cholecystosis, the other variant being adenomyosis. These changes are.  more commonly seen in the females, in the 4th and 5th decades and are usually asymptomatic.These changes are detected incidentally in 30-50% of cholecystectomy specimens.

Cholesterolosis results from abnormal deposits of cholesterol esters in macrophages within the lamina propria [foam cells] and in mucosal epithelium. The gall bladder may be affected in a patchy localized form or in a diffuse form.

The diffuse form macroscopically appears as a bright red mucosa with yellow mottling [due to lipid], hence the term ‘strawberry gall bladder.’ In its localized form, cholesterolosis may present as multiple, very small polyps.

This condition is not associated with an increased risk of malignancy and there is no known association with cholelithaisis and cholecystitis. Increased serum cholesterol level does not predispose to this condition. It is also not related to diabetes mellitus, atherosclerosis and hyperconcenteration of cholesterol in the bile.

Management

If the polyps are small, the patient may simply be followed up; larger polyps need elective cholecystectomy, if symptomatic. The main concern is to rule out gallbladder malignancy.