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JAMA Surgery Clinical Challenge |

A Woman With Abdominal Pain and Anemia QUIZ

Vasileios Mitrousias1; Evangelos Alexiou2; Anargyros Giaglaras1
[+] Author Affiliations
1Department of Surgery, General Hospital of Larissa, Koutlimbanio and Triantafylio, Larissa, Greece
2Department of Radiology, General Hospital of Larissa, Koutlimbanio and Triantafylio, Larissa, Greece
JAMA Surg. 2016;151(7):673-674. doi:10.1001/jamasurg.2016.0246.
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A 57-year-old woman presented to the emergency department with a 1 day history of upper abdominal pain. What is your diagnosis?

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Figure 1.

Anteroposterior abdominal x-ray film in erect position. In the right side of the mid to lower quadrant, at the level of L5 vertebral body, there is a rounded radio-opaque lesion (arrowhead) that seems to contain a second smaller sclerotic lesion within its central part (a lesion-in-lesion appearance).

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Figure 2.

Computed tomography of the abdomen, bone window. Within the gallbladder, there is a calcified rounded gallstone that incorporates a second rounded calcified stone (lesion-in-lesion appearance). A small hypodense rim is noted between the stones. Hepatomegaly and an external turn of the left kidney are also noted.

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