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What are the imaging findings?
Soft tissue thickening of the GB neck. There is also soft-tissue thickening of the GB fundus and a soft tissue nodule at the mid cystic duct. The cystic duct and the GB body and fundus are distended, indicating obstruction. Several centrally hypo-enhancing peritoneal nodules. Soft tissue nodule at the umbilicus (Sister Mary Joseph nodule)
What would be the next step in the management?
Although GB primary tumours can be biopsied under image guidance, there is a risk of biliary leak. Here the easiest and lowest risk option was to sample the lesion at the umbilicus.
- soft tissue thickening of the GB neck. There is also soft-tissue thickening of the GB fundus and a soft tissue nodule at the mid cystic duct. The cystic duct and the GB body and fundus are distended, indicating obstruction
- gallstones
- several centrally hypo-enhancing peritoneal nodules
- soft tissue nodule at the umbilicus
- indeterminate small liver lesions, likely benign cysts