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Image of the Month—Quiz Case

Image of the Month—Quiz Case A 36-year-old man sought care after 1 week of right upper quadrant and epigastric abdominal pain. He reported that the pain was dull, constant, at times radiated to his back, and was worse postprandially. He denied nausea, vomiting, fever, or chills. On initial examination, he was afebrile with moderate tenderness in the right upper quadrant, with no guarding or rebound. A right upper quadrant mass was visible and palpable. His white blood cell count was 16.3 × 103μL and the results of liver function tests were normal. A computed tomographic scan of the abdomen showed a markedly thickened and heterogeneous enhancing gallbladder wall (Figure 1). A gallbladder ultrasound revealed a grossly abnormal gallbladder with a thickened and hyperemic wall. Figure 1. View LargeDownload Computed tomographic scan of the abdomen shows a markedly thickened and heterogenous gallbladder with an enhancing gallbladder wall and very narrowed lumen. An open cholecystectomy was performed. The gallbladder was found to be hard and extremely edematous. Opening the removed gallbladder revealed a thickened gallbladder with a small lumen full of pigmented stones (Figure 2). Figure 2. View LargeDownload Gross pathology of gallbladder reveals diffusely inflamed and thickened walls with a narrowed lumen and areas of necrosis. A frozen section was performed on a piece of the wall. What Is the Diagnosis? A. Acute cholecystitis and chronic cholecystitis B. Parasitic infection of the gallbladder C. Gallbladder carcinoma D. Adenomyomatosis of the gallbladder Answer http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Archives of Surgery American Medical Association

Image of the Month—Quiz Case

Abstract

A 36-year-old man sought care after 1 week of right upper quadrant and epigastric abdominal pain. He reported that the pain was dull, constant, at times radiated to his back, and was worse postprandially. He denied nausea, vomiting, fever, or chills. On initial examination, he was afebrile with moderate tenderness in the right upper quadrant, with no guarding or rebound. A right upper quadrant mass was visible and palpable. His white blood cell count was 16.3 × 103μL and the results...
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Publisher
American Medical Association
Copyright
Copyright © 2006 American Medical Association. All Rights Reserved.
ISSN
0004-0010
eISSN
1538-3644
DOI
10.1001/archsurg.141.1.101
Publisher site
See Article on Publisher Site

Abstract

A 36-year-old man sought care after 1 week of right upper quadrant and epigastric abdominal pain. He reported that the pain was dull, constant, at times radiated to his back, and was worse postprandially. He denied nausea, vomiting, fever, or chills. On initial examination, he was afebrile with moderate tenderness in the right upper quadrant, with no guarding or rebound. A right upper quadrant mass was visible and palpable. His white blood cell count was 16.3 × 103μL and the results of liver function tests were normal. A computed tomographic scan of the abdomen showed a markedly thickened and heterogeneous enhancing gallbladder wall (Figure 1). A gallbladder ultrasound revealed a grossly abnormal gallbladder with a thickened and hyperemic wall. Figure 1. View LargeDownload Computed tomographic scan of the abdomen shows a markedly thickened and heterogenous gallbladder with an enhancing gallbladder wall and very narrowed lumen. An open cholecystectomy was performed. The gallbladder was found to be hard and extremely edematous. Opening the removed gallbladder revealed a thickened gallbladder with a small lumen full of pigmented stones (Figure 2). Figure 2. View LargeDownload Gross pathology of gallbladder reveals diffusely inflamed and thickened walls with a narrowed lumen and areas of necrosis. A frozen section was performed on a piece of the wall. What Is the Diagnosis? A. Acute cholecystitis and chronic cholecystitis B. Parasitic infection of the gallbladder C. Gallbladder carcinoma D. Adenomyomatosis of the gallbladder Answer

Journal

Archives of SurgeryAmerican Medical Association

Published: Jan 1, 2006

Keywords: abdomen,gallbladder,nausea and vomiting,ultrasonography of gallbladder,cholecystectomy, open,cholecystitis, acute,edema,chronic cholecystitis,epigastric pain,fever,frozen sections,gallbladder diseases,chills,liver function tests,pain,parasitic diseases

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