Presentation
Sporadic and nonspecific pain in the upper right quadrant of the abdomen. No jaundice is observed. Morbid obesity.
Patient Data
A series of sonographic images from a Liver study is presented.
Multiple circumscribed hypoechoic lesions scattered in the hepatic parenchyma are observed.
Adjacent to the medial margin of the gallbladder, there is an area of heterogeneous and poorly defined echogenicity, without appreciable separation plane between the wall of the gallbladder and the liver parenchyma, which shows vascularity in color Doppler mode.
Free fluid in the abdominal cavity, as well as thickening of the margins of the peritoneum towards the anterior side of the abdominal wall.
Other findings: Stones inside the gallbladder, mild hepatic steatosis.
The kidneys and spleen are normal.
Case Discussion
There are three behavior patterns described for gallbladder carcinomas: intraluminal mass, diffuse mural thickening and gallbladder replacement by mass. This case shows a heterogeneous mural thickening with data of invasion of the hepatic parenchyma. Approximately in 60% of cases, there are associated gallbladder stones, which are a risk factor.
Other findings that suggest the possibility of malignancy are nodular lesions highly suspicious for metastatic disease dispersed in the hepatic parenchyma, as well as ascites and thickening in the margins of the peritoneum, which may indicate a peritoneal extension of the disease.
Clinically, patients present nonspecific symptoms and otherwise remain asymptomatic, so the detection of gallbladder carcinoma occurs when the disease is already advanced, as in this case.