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Answer: Gallbladder sludge
Gallbladder sludge appears as a low amplitude homogeneous echoes, layering on the posterior wall, and frequently forming fluid-fluid level with anechoic bile above it. Mobility is not always demonstrated, therefore, raising differentials with polyps or gallbladder carcinoma.
In this case, B-mode ultrasound shows a hypoechogenic well defined intraluminal mass, with no posterior acoustic shadowing and an incomplete septum of the gallbladder.
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Case courtesy of Prof Adrian Săftoiu