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Standard ultrasound is an excellent method for assessing gallbladder disease. Despite the well-known advantages of conventional ultrasound, the sensitivity and accuracy are not satisfactory, especially when stones or some other gallbladder lesions fill the gallbladder lumen. Sometimes the bladder sediment may present as an intraluminal mass and mimic tumors such as gallbladder cancer or adenoma. With no information of micro vascularity differential diagnosis between benign diseases from malignant diseases is sometimes very difficult using conventional ultrasound, but CEUS can be a useful tool. The study was performed in the Gastroenterology Clinic of SCJU Craiova during 2018-2022. 38 patients with ultrasound-detected gallbladder formations were included. The reference methods for diagnosis were histological examination or computed tomography in cases without operative indication. A single experienced physician with more than fifteen years' experience performed CEUS examinations by applying a second-generation blood pool agent (SonoVue®, Bracco, Milan, Italy). Archived images were interpreted by the same physician and compared to the final diagnosis. There were 12 malignant and 26 benign gallbladder lesions in total in this study, including 12 cases of gallbladder cancer, 16 case of gallbladder sludge and 10 cases of gallbladder polyps. All the cases of gallbladder sludge were shown as completely nonenhanced on CEUS, and the diagnostic accuracy was 100%. CEUS exam shows homogeneously hyperenhanced on arterial phase and isoenhanced on venous phase in gallbladder polyps, The appearances of gallbladder cancer on CEUS were various: a mass in gallbladder which was heterogeneously hyperenhanced on arterial phase and washed out quickly or an irregular thickness of gallbladder, which was also heterogeneously hyperenhanced on arterial phase and washed out quickly. Gallbladder sludge and gallbladder cancer had completely different features on CEUS and the diagnostic accuracy was very high. CEUS is a feasible alternative tool to differentiate gallbladder pathologic alterations. [ABSTRACT FROM AUTHOR]