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JAMA Surgery Clinical Challenge
March 2015

Greatly Enlarged Thickened Gallbladder

Author Affiliations
  • 1Service de Chirurgie Digestive et Transplantation, University Lille Nord de France, Centre Hospitalier Universitaire Lille
JAMA Surg. 2015;150(3):267-268. doi:10.1001/jamasurg.2014.492

A woman in her 60s presented to the hospital because she felt abdominal pain and increasing asthenia during the previous 4 months. She reported a weight loss of 40 kg during the previous 12 months concomitant with depression. The patient had a history of cardiac arrhythmia, hypertension, and sigmoidectomy for diverticulitis. Medications included lasilix, amlodipine, amiodarone, and atenolol.

On examination, the patient appeared well. Her vital signs were normal. The abdomen was soft without distension. A positive Murphy sign was observed. Her white blood cell count was 11400/μL (to convert to ×109/L, multiply by 0.001), her hemoglobin level was 11.5 g/dL (to convert to g/L, multiply by 10.0), and her platelet count was 233 ×103/μL (to convert to ×109/L, multiply by 1.0). The C-reaction protein level was elevated to 41 mg/L (to convert to nmol/L, multiply by 9.524). The results of renal and liver function, coagulation, blood level of electrolytes, total protein, albumin, antigen carcino embryonnaire, carbohydrate antigen 19-9, carbohydrate antigen 125, and β2 microglobulin tests were normal. The patient had a normal esophagogastroduodenoscopy and colonoscopy. Ultrasonography revealed a 10 × 8-m mass in the right hypochondrium. Abdominal computed tomography scan revealed a thickened gallbladder wall infiltrating the liver parenchyma. There were 3 perihepatic lymph nodes. Magnetic resonance imaging showed a greatly enlarged gallbladder with a thickened wall without invading adjacent structures, a continuous mucosal line, and a hypoattenuated intramural nodule (Figure 1).

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