Demystifying a thickened and calcified gall bladder in the era of multimodality imaging

Description

A 74-year-old woman presented with a 6-month history of significant postprandial nausea and mild abdominal discomfort. She was fit and well with a surgical history of appendicectomy.

Routine blood tests including full blood examination and liver biochemistry were normal. Ultrasonography (US) demonstrated a thickened and calcified gall bladder. This was also confirmed on CT which showed concentric thickening and calcification of the gall bladder wall that was equivocal for an underlying malignancy associated with a large gallstone (figure 1).

Figure 1

CT in the (A) axial and (B) coronal sections show concentric thickening of the gall bladder wall with minor calcifications associated with cholelithiasis (indicated by the white arrow).

Interestingly, further imaging by MRI demonstrated an unexpected but definitive diagnosis of an 8 cm gallstone within a thin-walled gall bladder (figure 2). Based on the above investigations, an underlying malignant process was considered...

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