📄 SCRS

Limy bile
(Milk of Calcium Bile)

Limy bile (Milk of Calcium Bile) ultrasound case study

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Reporting Panel

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Gall bladder Pathology

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USG

Limy bile (Milk of Calcium Bile) ultrasound case study

Case Study Record

SN	Case Name	Report Line
1	Limy bile (Milk of Calcium Bile)	View Report Line
2	-	-
3	-	-
4	-	-
5	-	-

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CASE–1
Limy Bile (Milk of Calcium Bile)

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Clinical History

A 48-year-old female presented with recurrent right upper abdominal pain, particularly after meals. There was no history of jaundice or fever. Ultrasound examination of the hepatobiliary system was performed to evaluate suspected gallbladder pathology.

Ultrasound Findings

Ultrasound examination demonstrates a dependent echogenic material within the gallbladder lumen, producing dense posterior acoustic shadowing. The echogenic material layers dependently and changes position with patient movement, consistent with limy bile (milk of calcium bile). The gallbladder wall is normal in thickness without pericholecystic fluid. No intraluminal soft tissue mass is identified. The common bile duct is normal in caliber, and there is no evidence of intrahepatic biliary dilatation.

Gallbladder USG image. Longitudinal sonographic image demonstrates dependent echogenic milk of calcium bile (limy bile) within the gallbladder lumen producing dense posterior acoustic shadowing, without evidence of an intraluminal soft tissue mass.

Report Line

Dependent highly echogenic material producing dense posterior acoustic shadowing is noted within the gallbladder lumen, demonstrating positional layering, consistent with limy bile (milk of calcium bile). No gallbladder wall thickening, pericholecystic fluid, or biliary ductal dilatation is identified.

Impression

Limy bile (Milk of Calcium Bile) within the gallbladder.
No sonographic evidence of acute cholecystitis.

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Recommendation

Correlate with the patient's clinical symptoms and liver function tests. Surgical consultation may be considered in symptomatic patients or when associated with gallstones or chronic cholecystitis. Asymptomatic patients may be managed conservatively with clinical follow-up.

Key Learning Points

• Limy bile (milk of calcium bile) is a rare condition caused by precipitation of calcium carbonate within the gallbladder.
• Ultrasound demonstrates dependent echogenic material with dense posterior acoustic shadowing.
• The echogenic material typically layers dependently and changes position with patient movement.
• The gallbladder wall is often normal unless associated with chronic cholecystitis.
• Most cases are associated with cystic duct obstruction and may coexist with gallstones.
• CT typically demonstrates high-attenuation calcium-containing bile within the gallbladder.
• Differential diagnoses include gallstones, biliary sludge, porcelain gallbladder, emphysematous cholecystitis, and gallbladder neoplasm with calcification.

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