68 year old female complaining of vague right upper abdominal pain for many months. Ultrasound showed multiple echogenic foci with acoustic shadowing within the lumen of the gallbladder. These are consistent with multiple gallstones.
The gallbladder wall is thickened and multiple echogenic mural foci are seen. This is comet tail everberation artifacts and consistent with adenomyomatosis. The artifacts are due to acoustic shadow from cholesterol crystals within the lumina of Rokitansky-Aschoff sinuses.