Gallstones and bone metastases on MRCP

Case contributed by Dr Vikas Shah

Presentation

Right upper quadrant pain with raised alkaline phosphatase. Stones seen in gallbladder on ultrasound. MRCP requested to look for bile duct stones. Past history of breast cancer.

Patient Data

Age: 70
Gender: Female
MRI

MRCP

There are stones within the neck of the gall bladder but none seen within the bile ducts with no bile duct dilatation. There are no focal liver lesions. The pancreas and pancreatic duct look normal. A simple left renal cyst is present.

The most significant finding is of multiple vertebral body lesions, the largest involving the right posterior body of L1, extending to involve and expand the right sided pedicle. This is highly suspicious for a metastatic deposit. Subsequent CT confirmed widespread bony metastatic disease, confirmed to be from breast cancer.

Case Discussion

This case illustrates the importance of:

  1. Reviewing all of the structures on the images, particularly those outside of the main organ of interest - a significant number of important and unexpected diagnoses can be made.
  2. Relating the imaging findings to the clinical presentation, in particular when the main findings do not explain the presentation.
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Case information

rID: 46834
Case created: 19th Jul 2016
Last edited: 21st Jul 2016
Inclusion in quiz mode: Included

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