Milk of Calcium Bile

 

General Considerations

• Rare disorder in which gallbladder (GB) lumen is filled with a semi-solid, radio-opaque material
• Mostly calcium carbonate with calcium bilrubinate or calcium phosphate in a milky liquid
• Gallbladder stasis from longstanding cystic duct obstruction and cholelithiasis have been implicated in its formation
• It may be a long-term complication of total parenteral nutrition
• Predominately affects adults
• Milk of calcium may form in many other structures besides the gallbladder

 

Other Locations for Milk-of-Calcium
Milk of calcium kidney cysts	Calyceal diverticula
Cysts in the breast	Urethral diverticulum
Bronchogenic cyst	Mullerian duct cyst

 

Clinical Findings

• May be asymptomatic
• The same as chronic cholecystitis

Imaging Findings

• Dense opacification of the gallbladder lumen seen on CT or conventional radiography
• Always associated with cholelithiasis or choledocholithiasis
• May form fluid-fluid level in conventional radiographs exposed with horizontal beam
• On ultrasound-intermediate density between sludge and gallstones
• Dense material settles In most dependent part of GB and may shadow     

Differential Diagnosis

• Excretion of contrast into from a recent IV contrast injection
• Porcelain gallbladder

Treatment

• Surgical removal of GB is treatment of choice
• May pass spontaneously out of the GB

Complications

• Acute cholecystitis
• Pancreatitis
• Obstructive jaundice