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.
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.