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Case of the Month

February 2015

Patient Data: Female patient 62 years old

Clinical Info: Patient has pain in the right upper abdomen and fever

The pain in the right upper abdomen was caused by a large stone in the gallbladder neck

The gallbladder wall is thickened

There is also an abnormal mass in the gallbladder

Another image of the mass

There are color signals in the mass

Another image of the color signals

There seem to be a lot of color signals in the mass, but are these color signals really vessels

56979-Mijn_Film_1.swf An MRI was performed

56980-Mijn_Film_3.swf Another MRI

This is the gallbladder of a 65 year old male patient

Does this patient have a gallbladder carcinoma

The lesion is limited to the fundus of the gallbladder and there is a tiny color Doppler signal

There is a liver metastasis

Does the liver metastasis change your diagnosis

The CT scan shows a lungcarcinoma and a metastasis in the sternum

This is the CT scan of the gallbladder

A mass in the gallbladder can be a real tumor mass like a polyp or possibly a carcinoma or it could be tumefactive bile. A thickened gallbladderwall can also mean that there is a gallbladder carcinoma A color Doppler can be helpful but also confusing Be careful with interpreting color doppler signals because crystals within the sludge or thichened wall can give rise to twinkle artefacts. The first patient was operated and in this case the mass proved to be tumefactive bile and not a real tumor. The second patient had an adenomyomatosis of the gallbladder and a metastasized lungcarcinoma with liver and skletetal metastases

For more cases of gallbladder carcinoma, sludge and adenomyomatosis see

Copyright © Dr. T.S.A. Geertsma, Ziekenhuis Gelderse Vallei, Ede, The Netherlands. All rights reserved.

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