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Images of Memorable Cases: Case 19

Module by: Herbert L. Fred, MD, Hendrik A. van Dijk

Case_19-pres1-1.jpg

Plain abdominal radiograph of an 84-year-old woman who presented with a three-month history of diffuse abdominal pain and weight loss of 40 pounds. On physical examination, she had a hard, nontender, baseball-sized mass in the right upper abdominal quadrant.

19. Porcelain gallbladder with probable metastatic carcinoma of the gallbladder

A computed tomographic scan showed that the calcification seen on the plain abdominal radiograph represented the wall of the gallbladder (image below). The scan also showed ascites, multiple lesions in the liver, and nodularity of the peritoneum and small bowel mesentery. These findings suggested metastatic carcinoma of the gallbladder, but the patient refused further investigation.

Case_19-diag1-1.jpg

Calcification of the gallbladder wall—referred to as “porcelain gallbladder”— is a rare form of chronic cholecystitis affecting women predominantly. It should always be considered in the differential diagnosis of a calcified lesion in the right upper abdominal quadrant. Confirmation of porcelain gallbladder can be achieved by ultrasonography or computed tomography. Because patients with a calcified gallbladder have an increased risk of gallbladder cancer, cholecystectomy is indicated in most cases.

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