July 4, 1980

Unusual Cause of Nonopacification of the Gallbladder During Oral Cholecystography

Author Affiliations

From the Department of Radiology, North Shore University Hospital, Manhasset, NY, and the Cornell University Medical College, New York.

JAMA. 1980;244(1):71-72. doi:10.1001/jama.1980.03310010057035

History  An 88-year-old woman was admitted to the hospital because of a 27-kg weight loss during a one-year period and pain in the right upper quadrant and epigastrium. She denied dysphagia, vomiting, or melena. She complained of easy fatigability and malaise and had hypochromic normocytic anemia. A two-day oral cholecystogram resulted in nonvisualization of the gallbladder. On the second day, a chest roentgenogram was obtained and an upper gastrointestinal (GI) tract series was performed (Fig 1 and 2).

Diagnosis  Esophageal carcinoma causing total obstruction of the esophagus.

Comment  The arrows in Fig 1 point to the iopanoic acid tablets that are trapped in the esophagus. Figure 2 shows total obstruction of the midesophagus by a carcinoma. Note the excessive secretions and contrast material above the lesion. As a result of the obstruction, the iopanoic acid tablets never reached the small intestine to be broken down and then conjugated by the