A 56-year-old woman comes to the office due to abnormal gallbladder imaging. Three weeks ago, she went to the emergency department due to cough and fever. Chest radiography revealed right upper quadrant calcifications in the gallbladder region but no acute lung findings. Since then, the patient's cough and fever have resolved, and she feels well. She has no history of gallstones and has had no abdominal pain, nausea, vomiting, jaundice, or clay-colored stool. The patient has a history of hypertension and takes lisinopril. She does not use tobacco, alcohol, or illicit drugs. Vital signs are within normal limits. BMI is 28.5 kg/m². Physical examination reveals no abnormalities. CT scan of the abdomen reveals several small gallstones with no biliary duct dilation. Patchy areas of gallbladder wall calcification are present without edema or masses. Which of the following is the best recommendation for this patient?

Question

Quizplus · Accepted Answer

Explanation: Porcelain gallbladder is characterized by the development of punctate or curvilinear calcifications within the gallbladder wall due to chronic cholelithiasis. Most patients are asymptomatic; diagnosis is usually made when gallbladder wall calcifications are incidentally found on abdominal imaging for other conditions. calcifications Patients with porcelain gallbladder are at increased risk for gallbladder cancer and often require prophylactic cholecystectomy if they have symptoms of gallbladder disease (eg, biliary colic) or if punctate calcifications are present. Curvilinear gallbladder calcifications minimally increase cancer risk and generally do not require intervention. (Choice A) Calcification of the gallbladder wall is thought to be due to chronic inflammation, not hypercalcemia. Hypercalcemia increases the risk of nephrolithiasis but is not closely associated with gallstones. (Choice C) Most asymptomatic gallstones do not require treatment. However, patients with porcelain gallbladder are at increased risk for cancer and often require prophylactic cholecystectomy. (Choice D) Ursodeoxycholic acid is usually given to patients with small, noncalcified gallstones who have mild symptoms of biliary colic. This patient, who is asymptomatic with punctate gallbladder calcifications, requires evaluation for prophylactic cholecystectomy. (Choice E) Porcelain gallbladder is typically diagnosed by imaging; biopsy does not determine the need for cholecystectomy. Educational objective: Porcelain gallbladder is often found incidentally on imaging and is associated with an increased risk of gallbladder cancer. Patients with punctate calcifications or symptoms of biliary colic are usually referred for prophylactic cholecystectomy to reduce cancer risk. References: Reassessing the need for prophylactic surgery in patients with porcelain gallbladder: case series and systematic review of the literature. (http://www.ncbi.nlm.nih.gov/pubmed/22006872) Laparoscopic cholecystectomy in patients with porcelain gallbladder based on the preoperative ultrasound findings. (http://www.ncbi.nlm.nih.gov/pubmed/15239221)

A 56-Year-Old Woman Comes to the Office Due to Abnormal