With the development of the economy and the improvement of people’s health awareness, medical checkups are becoming more and more popular, and we often encounter some patients who are very nervous in the clinic. What we usually call “gallbladder polyp” is a superfluous organism growing on the gallbladder, in fact, this is a more general term, its more accurate term is “gallbladder polyp-like lesion”. Depending on the nature of the pathology, they can be divided into two categories: non-neoplastic lesions and neoplastic lesions. Non-neoplastic lesions include cholesterol polyps, inflammatory polyps and adenomatous hyperplasia of the gallbladder. For this type of lesions, you can not be nervous, regular follow-up review can be done. Neoplastic lesions include gallbladder adenoma and gallbladder cancer. Gallbladder adenoma is a time bomb, although it is a benign lesion, it can be transformed into gallbladder cancer. Gallbladder cancer, on the other hand, is a more malignant tumor, often with a poor prognosis, and early surgical treatment can improve the survival rate of patients. Thus, it is crucial to correctly identify all types of gallbladder polyp-like lesions! At present, the commonly used imaging methods are ultrasound, CT, MRI, etc. Among them, conventional ultrasound is the first choice for the diagnosis of gallbladder polyp-like lesions. Non-neoplastic polyps mostly appear as multiple nodule-like protrusions with high echogenicity on ultrasound images, and blood flow signals are usually difficult to be measured. In adenomyosis, thickening of the gallbladder wall and its internal anechoic cyst may be observed on ultrasound images, and small stones with a posterior “comet’s tail” sign may be seen in the cystic cavity. Neoplastic lesions are relatively uncommon. Gallbladder adenomas are usually solitary and have a greater chance of becoming cancerous when the ultrasound image shows a lesion >10 mm in diameter, combined with stones, a non-tip and a wide base. Gallbladder cancer can be classified as nodular, thick-walled, massive, or mixed. Studies have shown that when the patient’s age is >52 years old, lesion diameter is >10mm, invasion of liver, gallbladder wall thickness is >5mm, especially combined with stones, the patient should be alert to the possibility of gallbladder cancer. With the progress of technology, many new ultrasound techniques are gradually applied to the diagnosis of diseases, and ultrasonography is one of them. It can make differential diagnosis according to the enhancement pattern and microvascular distribution characteristics of gallbladder polyp-like lesions, especially when there are spiny or branched microvascular distribution inside the lesion, which has higher specificity for the diagnosis of tumor polyp. Therefore, when patients find “gallbladder polyps” in physical examination, they can go to the hospital to do a general ultrasound examination first, and when tumor lesions are suspected, they can further perform ultrasonography to clarify their nature. Finally, to summarize: the gallbladder is small, but the role is not small, there are many types of polyps, open surgery when careful.