Contrast-enhanced ultrasound for differentiation of gallbladder sludge from polyp: A case report demonstrating clinical utility

Gallbladder lesion characterization remains a common diagnostic dilemma in abdominal imaging, particularly when differentiating between polyps and organized sludge. Findings on conventional gray-scale ultrasound may be equivocal, especially when typical imaging features such as mobility are absent. We present a case of a 65-year-old patient who presented with a concerning nonmobile 3.7 cm gallbladder lesion on initial ultrasound assessment. Due to the superior sensitivity of contrast-enhanced ultrasound (CEUS) for blood flow compared to other imaging modalities, CEUS was able to demonstrate complete absence of enhancement within the lesion, consistent with tumefactive sludge rather than solid tissue, and averting the need for additional cross-sectional imaging. Surgical pathology following cholecystectomy confirmed these findings. This case highlights the utility of CEUS as a valuable tool in gallbladder imaging, potentially reducing healthcare costs and expediting appropriate patient care while avoiding the risks associated with other contrast-enhanced imaging modalities.