Limy Bile Syndrome

The differential diagnosis includes gallbladder opacification by contrast material following oral cholecystography or endoscopic retrograde cholangiography, vicarious excretion due to renal or hepatic failure, and porcelain gallbladder. Discussion Limy bile syndrome (LBS), also known as milk-of-calcium gallbladder, is a rare idiopathic condition usually recognized by its distinct radiological features.13 The condition is characterized by dense opacification of the gallbladder, and seldom the bile ducts, with a creamy solution of calcium salts in the form of carbonate, oxalate, phosphate, or bilirubinate. Limy bile syndrome can be associated with hyperparathyroidism, chronic cholecystitis, gallstone-induced pancreatitis and, in very rare instances, gallbladder cancer or cholangiocarcinoma.5'6 This entity is usually diagnosed in patients older than 40 years, with a 3:1 female-to-male ratio.4 Only a few cases have been reported in pediatric patients.7 Most patients with LBS are asymptomatic; the condition is detected incidentally on imaging studies performed for unrelated abdominal disorders.1'8 However, some patients present with right subcostal pain, fever, and jaundice resulting from concurrent cholecystitis or biliary obstruction by gallstones.1'6 The typical finding on abdominal radiography and CT is that of a densely radiopaque gallbladder filled with a highly viscous substance, intraluminal calculi, and often obstructed by an impacted gallstone in its neck or cystic duct.