Case 139

 A seventy three-year-old male presented in our hospital with a letter of reference. He had been suffering from abdominal pain and fever for approximately 20 days. At first, he could not get medical service because he had to clean up the mess in his house when it was the time immediately after typhoon passed away. Five days after he experienced abdominal pain, he visited a local clinic and received abdominal echo examination which showed gall bladder stone and cholecystitis. Laboratory test revealed CRP 26 mg/dL, white blood cells 13600/mm³. He was given antibiotics, inducing symptoms relief. However, it also revealed CA19-9 2323 mg/mL. The letter of reference asked us further imaging examination whether gall bladder cancer was associated with or not, and further, medical care if necessary.

 He received abdominal enhanced CT using contrast medium (Figs1, 2) and abdominal MRI (Figs 3, 4) in our hospital.

What is your imaging diagnosis?

1. Gall bladder cancer

2. Bacterial Cholecystitis

3. Adenomyosis

4. Xanthogranulomatous cholecystitis

answer

2019.3.6