UCONN Emergency Medicine Interest Group

EM Images #11

In IMAGES, RADIOLOGY on March 11, 2012 at 2:09 PM

Syndicated from the UCONN EM Residency website; credit to Dr. London for images and text.

A 55 year old man came in with diffuse abdominal pain, mostly in RLQ, with tenderness and guarding there but no rebound. Questionable Rovsing’s.  Minimal RUQ findings. No Murphy´s sign. What are the diagnoses associated with this CT?

Patient had gallstones – NOT his problem. He also had appendagitis which was treated conservatively. BUT, the gallbladder with the stones was also a “porcelain gallbladder”. A “porcelain gallbladder” is one with calcium in the wall. There are two main types: (1) a broad continuous band of calcification in the muscularis and (2) multiple punctate calcifications in the mucosa and glandular spaces of the mucosa. The significance of a porcelain gallbladder, which is usually an incidental finding in a patient asymptomatic vis-à-vis the biliary system (as in our patient), is that it can be a pre-cancerous (carcinoma of GB) condition. Although there are the two types as mentioned above, with perhaps a difference in the malignant potential, it seems clear to me that this finding warrants a mandatory referral to either GI or surgery. “Porcelain GB” (calcium in wall) is to be distinguished from “milk of calcium GB” (calcium in bile); milk of calcium GB bile results from precipitation of particulate matter with high concentrations of calcium carbonate, calcium phosphate, or calcium bilirubinate. It is associated with chronic cholecystitis and gallstone obstruction of the cystic duct.

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