The case of a 53-year-old female with abdominal pain is presented. Abdominal ultrasound was unremarkable, a HIDA scan demonstrated biliary dyskinesia, and a computed tomography scan of the abdomen and pelvis revealed an intraluminal gallbladder hyperdensity suspicious for a gallstone. A laparoscopic cholecystectomy was performed and, on pathologic examination, no gallstones were present. Microscopically, a focus of bone metaplasia of the gallbladder mucosa was noted. No other lesions were identified. Bone metaplasia of the gallbladder is a rare event of unknown clinical significance that may be clinically confused with cholelithiasis affecting treatment options. © 2009 Southern Medical Association.