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Plain abdominal radiograph of an 84-year-old woman who presented with a three-month history of diffuse abdominal pain and weightloss of 40 pounds. On physical examination, she had a hard, nontender, baseball- sized mass in the right upper abdominal quadrant.
A computed tomographic scan showed that the calcification seen on the plain abdominal radiograph represented the wall of thegallbladder (image below). The scan also showed ascites, multiple lesions in the liver, and nodularity of the peritoneum and small bowel mesentery. Thesefindings 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 affectingwomen 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 anincreased risk of gallbladder cancer, cholecystectomy is indicated in most cases.
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