Mural thickening of the gallbladder? Look to the heart of the problem

The differential diagnosis for mural thickening of the gallbladder is broad and includes many extra-cholecystic conditions, especially in pediatrics. Primary cholecystitis is a rare cause of right upper quadrant pain in children <10 years of age presenting to the emergency department. Here we present the case of a child transferred to a pediatric emergency department due to concern for cholecystitis, radiographically diagnosed with gallbladder wall thickening as the presenting sign of infectious endocarditis with progressive left ventricular failure. Learning objective: Mural thickening of the gallbladder in the pediatric patient should prompt clinicians to think broadly about its etiology spanning several organ systems, including cardiac disease.