Review Question - QID 104862

The patient in this vignette most likely has chronic biliary colic with gallbladder calcifications (porcelain gallbladder). This condition puts the patient at increased risk of gallbladder carcinoma.

The management of gallbladder disease is very high yield for board examinations. As a rule, asymptomatic patients do not require cholecystectomy. Patients at risk for cancer should have cholecystectomy, including Native Americans and patients with porcelain gallbladder. The most common cause of porcelain gallbladder is recurrent biliary colic. It should be noted that indications for gallbladder surgery are not only due to heightened risk of cancer, as patients who are admitted for their first episode of biliary colic should have a cholecystectomy that admission.

Hoover et al. discuss calcifications of the right upper quadrant seen on imaging. It is a rare finding, but may indicate disease in the gallbladder, adrenal glands, kidneys, pancreas, lungs, or chest wall. The most common diseases with calcification in this region include porcelain gallbladder, echinococcal cysts, calcified renal cysts, chest wall masses, and degenerative cystic lesions of the pancreas and adrenal glands.

Schnelldorfer performed a review of 340 patients with porcelain gallbladder. This article reports a lower than previously anticipated risk of gallbladder carcinoma. However, since a stratification of at risk patients is lacking, prophylactic cholecystectomy is recommended for otherwise healthy patients while a non-operative approach should be considered in patients with surgical risk.

Figure A displays a porcelain gallbladder on abdominal CT scan. Note the radiopaque gall bladder wall in the right upper quadrant.

Incorrect answers:
Answer 1: Calcifications of the pancreas are a mark of chronic pancreatitis. The calcifications in this scan are not of pancreatic origin.
Answer 3: Hepatocellular carcinoma is not a sequela of a porcelain gallbladder.
Answer 4: Aneurysm rupture is not a sequela of a porcelain gallbladder.
Answer 5: Echinococcal cysts can be detected as calcifications, but the scan in this vignette shows gallbladder calcifications.