Images in Clinical Medicine

Porcelain Gallbladder

Steffen Rickes, M.D., and Kenneth Ocran, M.D.

N Engl J Med 2002; 346:e4April 4, 2002

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Figure 1 A 45-year-old woman was hospitalized with a seven-day history of fever and pain in the right upper abdomen. Ultrasonography (Panel A) showed gallstones (large arrows), including one in the cystic duct, leading to an enlargement of the gallbladder (diameter about 5 cm) and calcification of the wall (small arrows). Computed tomography (Panel B) confirmed the presence of calcification of the gallbladder wall, or porcelain gallbladder (small arrow), and gallstones (large arrow). The patient declined cholecystectomy, which is the usual treatment, and was treated with antibiotics. Two weeks later, the fever and pain had resolved.

A large, solitary calcification in the right upper abdomen may indicate disease of the gallbladder, adrenal glands, kidneys, lungs, or chest wall. With respect to the diagnosis of porcelain gallbladder, ultrasonography is as sensitive as abdominal radiography and computed tomography. Patients with a calcified gallbladder have an increased risk of gallbladder cancer.

Steffen Rickes, M.D.
Kenneth Ocran, M.D.
University Hospital Charité, 10117 Berlin, Germany