This is a plain abdominal Xray of 72-year-old woman who presented with abdominal pain  especially after eating which was associated with nausea and vomiting .And on examination of that woman, doctor revealed that she was icteric and there was a palpable mass on the right upper quadrant of the abdomen.




Identify the Xray?
What is the possible complication of this condition that she may be having in future?




ANSWER

PORCELAIN GALLBLADDER
(calcifying cholecystitis, or cholecystopathia chronica calcarea)


Porcelain gallbladder means the wall of the gallbladder has been calcified to a hard and bluish white texture resembling porcelain ceramic. 


It is predominantly found in overweight female patients of middle age.(male-to-female ratio is 1:5)


Gallstones are present in 90% of patients with porcelain gallbladder


Low-grade chronic inflammation(chronic cholecystitis)t intramural hemorrhage and an imbalance in calcium metabolism are implicated for the condition


Occurrence of gallbladder carcinoma(commonly adeno carcinoma) is remarkably high in patient with porcelain gallbladder and patients with gallbladder carcinoma usually have a poor prognosis

CLINICAL FEATURES

  1. Abdominal pain (especially after eating)
  2. Jaundice
  3. Vomiting
  4. Palpable mass may occasionally be found

INVESTIGATIONS

  • Plain abdominal Xray-galllbladder is seen as having semi radiolucent appearance
  • Non-functioning gallbladder on oral cholecystogram
  • Ultrasound Scan
  • CT Scan

TREATMENT

Prophylactic cholecystectomy to prevent gallbladder carcinoma


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22 comments

  1. Anonymous Says:
  2. arash from iran


    very easy case
    porcelin gall bladder , i has risk of gall bladder cancer , removal should be done as soon as possibe

     
  3. gall stone:
    its plain xray showing rt part of the abdomin and part of the chest and pelvis
    the skeleton shows no abnormailties
    intestinal loops showing no abnormalities
    oval shaped opacities (6*2 cm) in the rt upper part..
    mostly gall stone

    possible complications:
    billiary pancreatitis
    cholecysitis (AS a cause or complication)
    illus
    malignancy if chronic and long standing
    cholengitis
    and jundice (symptom or compication)

     
  4. Anonymous Says:
  5. ileo biliare

     
  6. Anonymous Says:
  7. i agree with procelin gallbladder.....but have to differentiate with hydatid cyst too.....they sometimes mimic.....

     
  8. dr.ain Says:
  9. procelein gall bladder, calcified but clinical picture is more consitent with carcinoma of gall bladder which is the complication, procelein gall bladder per se is not palpable

     
  10. Anonymous Says:
  11. may i know what is procelin gall bladder??

     
  12. Anonymous Says:
  13. porcelain gall bladder, i agree... old woman, complication of this is carcinoma of gall bladder, i think...

     
  14. Anonymous Says:
  15. @anonymous..may i know what is procelin gall bladder??...
    I think its porcelain gall bladder..it means calcification of the gall bladder...

     
  16. Anonymous Says:
  17. ....porcelain gall bladder...calcification of the gall bladder wall,,.

     
  18. Anonymous Says:
  19. Acute on chronic pancreatitis due to gall stone

     
  20. Admin Says:
  21. Porcelain gallbladder means the wall of the gallbladder has been calcified to a hard and bluish white texture resembling porcelain ceramic. This medical condition primarily results from a chronically inflamed organ. When many gallstones collect in the gallbladder, it becomes irritated, and precipitates calcification that might necessitate surgery.

     
  22. Anonymous Says:
  23. porcelain gall bladder
    Its associated with the nausea and the abdominal pain especially after eating

     
  24. Anonymous Says:
  25. i am learning here and i agree to the porcelain gall bladder theory

     
  26. Anonymous Says:
  27. porcelin gb....d/d calcified wall hydatid cysts.....compli---gb carcinoma

     
  28. Anonymous Says:
  29. dr elkut
    Usually Inflamed gall bladder does not cause a palpable mass in the Rt upper Q of the abdomen
    also infalmed gall bladder and GB stones does not cause jaundice
    I think it is ca. head of pancreas or a stone impacted in the CBD causing pancreatitis

     
  30. Anonymous Says:
  31. it maybe cance pancreas
    as gall stones rarely causes enlarged gall bladder
    caurvoisier law

     
  32. Anonymous Says:
  33. Porcelain gallbladder means the wall of the gallbladder has been calcified to a hard and bluish white texture resembling porcelain ceramic. This medical condition primarily results from a chronically inflamed organ. When many gallstones collect in the gallbladder, it becomes irritated, and precipitates calcification that might necessitate surgery.
    As U can c 4m the X-Ray The Sea-Gull (Mercedes Benz) Sign is very Prominent so its Case of Po9rcelin Gall Bladder and Complication Will Be Ca GB

     
  34. Anonymous Says:
  35. its porcelain gall bladder
    dr Bobby

     
  36. Anonymous Says:
  37. Porcelain gall bladder,,,, it has been some time since I last saw a case being a bit rare. High risk of malignant transformation.

    anm

     
  38. Anonymous Says:
  39. Sohiab Zahid, Medical student from Dow Medical College: First i want to thank the administrator of this Bolg that he has given us a wonderful oppertunity to learn and discuss..and spread of knowledge.
    I think this abdominal x-ray of patient has an opacity on rt. upperquadrant..anatomically this leison can be associated with gall bladder pathology. as the size and shape of opacity defines it. most probably it is calcified gall bladder

     
  40. shaheel Says:
  41. TREATMENT FOR CHEST PAIN
    Chest pain is considered a chief symptom of heart related problems. It can occur due to various causes such as heart attack, pulmonary embolism, thoracic aortic dissection, oesophageal rupture, tension pneumothorax and cardiac tamponade.

    By conducting several medical tests, the above causes could be ruled out or treated as recommended by medical professionals. If acute chest pain occurs, the patient should be admitted immediately for observation and sequential E.C.G.'s are followed up.

    Just like in all medical cases, a careful medical history and detailed physical examination is essential in separating dangerous from minor/trivial causes of disease. Sometimes, there is need of rapid diagnosis to save life of patient. A deep study of recent health changes, family history, tobacco consumption, smoking, diabetes, eating disorders, etc. is useful in treatment of chest pain.

    Features of chest pain could be generalised as heaviness; radiation of the pain to neck, jaw or left arm; sweating; nausea; palpitations; pain coming from exertion; dizziness; shortness of breath and a sense of impending doom. On the basis of these characteristics, a number of tests can be carried out for proper treatment. X-ray and CT scan of the chest help in determining the basic cause of pain. An electrocardiogram helps in detailed study of the problem.

     
  42. Anonymous Says:
  43. Hi, I'm going to be a patient soon (I hope not!) I went to see a general physician last Monday to complain about the severe abdominal pain I had (right part) which lasted from 10pm (Sat) to 4am (Sun). The doctor thought it's my kidney then I underwent an Xray test. Based on the radiological report, he found a 2.7cm oval calcification which is suggestive of gallstone. And he referred me to a specialist. I was only able to get a slot from the hospital on August 1, which is a long wait (it's 8th June now)! I searched for the term 'calcification in gallbladder' which has led me to your website. And thats the exact image I saw (except of the size of calcification).
    Well, I assumed that my case will not be that major because they scheduled me for a long wait of testing! Do you think I need urgent testing for this??? I'm scared to know that it's a PORCELAIN gallbladder which will lead to cancer if not treated urgently :( Please help!

     

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