A 59-year-old woman comes to the office for a routine visit. She reports no symptoms. She has no medical problems and takes no medications. She grew up in the United States and has not traveled outside the country. The patient does not use tobacco, alcohol, or illicit drugs. Her blood pressure is 120/70 mm Hg, pulse is 88/min, and respirations are 14/min. Physical examination shows a firm, nontender mass in the right upper quadrant. The remainder of the examination is within normal limits. Laboratory testing is unremarkable. Abdominal CT scan is shown in the image below. This patient is at greatest risk for which of the following conditions?

Question

A 59-year-old woman comes to the office for a routine visit.  She reports no symptoms.  She has no medical problems and takes no medications.  She grew up in the United States and has not traveled outside the country.  The patient does not use tobacco, alcohol, or illicit drugs.  Her blood pressure is 120/70 mm Hg, pulse is 88/min, and respirations are 14/min.  Physical examination shows a firm, nontender mass in the right upper quadrant.  The remainder of the examination is within normal limits.  Laboratory testing is unremarkable.  Abdominal CT scan is shown in the image below.  This patient is at greatest risk for which of the following conditions?

Quizplus · Accepted Answer

11ec25c8_d089_eead_bc81_359104aa8dd6_MD0003_00 This patient's abdominal CT scan shows a porcelain gallbladder, a term used to describe the calcium-laden gallbladder wall with bluish color and brittle consistency often associated with chronic cholecystitis. The pathogenesis of the condition remains unclear, but it is thought that calcium salts are deposited intramurally due to the natural progression of chronic inflammation or chronic irritation from gallstones. Patients can be asymptomatic, have right upper quadrant pain, or have a firm and nontender right upper quadrant mass on examination. bluish color and brittle consistency Plain x-rays can show a rimlike calcification in the area of the gallbladder, and CT scan typically reveals a calcified rim in the gallbladder wall with a central bile-filled dark area. Porcelain gallbladder has been associated with increased risk for gallbladder adenocarcinoma (2%-5% in some studies). Cholecystectomy is typically considered for patients with porcelain gallbladder, particularly if they are symptomatic or have incomplete mural calcification. (Choice A) Ruptured echinococcal cyst can cause anaphylaxis with eventual shock. However, an echinococcal cyst usually appears on abdominal CT as a cystic liver lesion (sometimes with calcifications) without gallbladder involvement. It would be unlikely in a patient who has never traveled outside the United States. echinococcal cyst (Choice C) Liver abscess is typically amebic or bacterial in origin (not a complication of porcelain gallbladder) and is caused by portal vein bacteremia, systemic bacteremia, ascending cholangitis, or trauma. Ultrasound or CT scan is usually diagnostic. CT scan (Choices D and E) Porcelain gallbladder is typically not directly associated with intestinal perforation or cirrhosis of the liver. Gallstone ileus can cause a fistula between the gallbladder and intestine, which allows gallstones to enter and obstruct the intestine. (Choice F) Risk factors associated with renal cell carcinoma (RCC) include smoking, hypertension, and obesity. However, porcelain gallbladder is not usually associated with increased risk for RCC. Educational objective: Porcelain gallbladder is usually diagnosed on abdominal imaging showing a calcified rim in the gallbladder wall with a central bile-filled dark area. It is associated with an increased risk for gallbladder adenocarcinoma and usually requires cholecystectomy. References: Porcelain gallbladder: a benign process or concern for malignancy? (http://www.ncbi.nlm.nih.gov/pubmed/23423431)

A 59-Year-Old Woman Comes to the Office for a Routine