Clinical Case of the Month

November

A previously healthy 34-year-old woman was admitted to the hospital with acute epigastric pain, a palpable abdominal mass, nausea, and weight loss of 2 kg in the last 2 weeks. Physical examination findings disclosed that the patient weighed 51 kg and was 170 cm tall, and was in good general health, with right upper quadrant tenderness, slight peritoneal symptoms, a nondistended abdomen, and normal bowel sounds. Body temperature was 38.2°C. The leukocyte count was slightly elevated at 9.800, and C-reactive protein level was 18 mg/L (reference, < 5 mg/L). A chest radiograph yielded normal findings. Abdominal sonography revealed a cystic lesion 8 x 4 cm in greatest diameter next to a small gallbladder, without other intra-abdominal pathologic findings. Subsequent magnetic resonance cholangiopancreatography confirmed the cystic lesion (Figure 1). Laparotomy revealed a cystic tumor 8 cm in greatest diameter at the lateral border of the hepatoduodenal ligament (Figure 2).

Figure 1. MRI of the abdomen shows a cystic lesion

Figure 2. View of the intraoperative site.

What is the Diagnosis?

A. Double gallbladder

B. Choledochal cyst

C. Cholangiocarcinoma

D. Liver abscess

* The answers can be posted as comments, or if you would prefer, you can email them to me (go to Contact Me). You can also see other clinical cases here.