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A 70-year-old man visited the emergency department with a 3-day history of right upper quadrant pain. He was febrile (temperature, 37.6°C) and his white blood cell count was 19 × 103/μL. His abdomen was soft and tender at the right upper quadrant with a positive Murphy sign.
He had a history of splenectomy for hereditary spherocytosis at age 40 years and a history of upper gastrointestinal tract bleeding from a gastric ulcer 7 years prior to admission. He had a gallstone disease for the last 12 years. The abdominal ultrasonographic scan showed acute cholecystitis with gallbladder wall thickening and pericholecystic fluid collection, and chest radiography revealed a mass of the right lower lobe (Figure 1). The patient underwent a cholecystectomy and had an eventful postoperative recovery. He was then referred to the chest physicians and had further investigation with a biopsy guided by magnetic resonance imaging (Figure 2) and computed tomography. Unfortunately, the histopathologic examination results of the biopsy specimen were inconclusive; thus, the patient underwent a right thoracotomy.
Stavrothanasopoulou A, Germanos S, Xipolitos A, et al. Image of the Month—Quiz Case. Arch Surg. 2008;143(12):1231. doi:10.1001/archsurg.143.12.1231
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