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Gallstones and bone metastases (MRCP)

Case contributed by Vikas Shah
Diagnosis almost certain

Presentation

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

Patient Data

Age: 70 years
Gender: Female

There are stones within the neck of the gall bladder, but none are 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 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 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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