Usually associated with gallstones, chronic cholecystitis presents with lower-grade, recurring right upper quadrant pain. The action of stones on the wall causes it to become fibrosed and irregularly thickened, frequently appearing hyperechoic (Fig. A). The gallbladder is often shrunken and contracted, having little or no recognizable lumen around the stones. Chronic cholecystitis may be complicated by episodes of acute inflammation on a background of the chronic condition. Most gallbladders which contain stones show at least some histological degree of chronic cholecystitis, even if wall thickening is not apparent on ultrasound.
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