Grace S.RozyckiMD, MBA
A previously healthy 34-year-old woman was admitted to our hospital with acute epigastric pain, a palpable abdominal mass, nausea, and weight loss of 2 kg in the last 2 weeks. Physical examination findings disclosed that the patient weighed 51 kg and was 170 cm tall, and was in good general health, with right upper quadrant tenderness, slight peritoneal symptoms, a nondistended abdomen, and normal bowel sounds. Body temperature was 38.2°C. The leukocyte count was slightly elevated at 9.8 × 109/L (reference, < 9.5 × 109/L), and C-reactive protein level was 18 mg/L (reference, < 5 mg/L) (to convert to nanomoles per liter, multiply by 9.524). A chest radiograph yielded normal findings. Abdominal sonography revealed a cystic lesion 8 × 4 cm in greatest diameter next to a small gallbladder, without other intra-abdominal pathologic findings. Subsequent magnetic resonance cholangiopancreatography confirmed the cystic lesion (Figure 1). Laparotomy revealed a cystic tumor 8 cm in greatest diameter at the lateral border of the hepatoduodenal ligament (Figure 2).
Magnetic resonance image of the abdomen shows a cystic lesion (C).
View of the intraoperative site. A small swab lies on the cystic lesion.
A. Double gallbladder
B. Choledochal cyst
D. Liver abscess
Banz V, Mahler K, Treumann T, Metzger J. Image of the Month—Quiz Case. Arch Surg. 2007;142(10):1007-1008. doi:10.1001/archsurg.142.10.1007