Gallbladder carcinoma

Case contributed by Dr Hidayatullah Hamidi

Presentation

Chronic right upper quadrant pain.

Patient Data

Age: 55 year
Gender: Female
Ultrasound

Diffuse marked wall thickening of gall bladder with obliteration of its lumen and engulfed gallstone with multiple supra centimetric enlarged porta hepatis and aortocaval lymph nodes with discrete hepatic hypoechoic lesions.

CT

- Diffuse marked wall thickening of the gall bladder is noted with obliteration of its lumen and engulfed gall stone (gallbladder carcinoma).
- Thrombosed upper part of the superior mesenteric vein, portal vein, and its branches.
- Multiple supra-centimetric enlarged porta-hepatis and aortocaval lymph nodes encasing the hepatic artery and portal vein and abutting the pancreatic head and duodenum. The largest lymph node measures 4 cm in short diameter.
- Branching hypo attenuation in the right lobe of liver (? Due to portal vein thrombosis) however there are multiple discrete hypoattenuating lesions in the right lobe of the liver (metastasis). The largest in segment V measures 1.8 x 1.8 cm.
- Marked pancreatic atrophic changes are seen.
- No dilatation of the intra and extrahepatic biliary channels is seen.
- There is evidence of a soft tissue lesion in the left adrenal gland measuring 2.3 x 2 cm (secondary deposit).
Spleen, right adrenal, both kidneys, stomach, bowel loops and pelvic organs are normal.
No ascites or pneumoperitoneum.
Anterior abdominal wall defect is noted with herniation of mesentery.

Case Discussion

The features are likely of gallbladder carcinoma with regional nodal involvement and hepatic metastasis.

Due to portal vein thrombosis appropriate opacification of the portal vein branches and liver parenchyma is not performed.

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