RT Journal
A1 Gordon PE, Miller DL, Rattner DW, Conrad C
T1 IMage of the month—quiz case
JF Archives of Surgery
JO Archives of Surgery
YR 2011
FD April 1
VO 146
IS 4
SP 487
OP 487
DO 10.1001/archsurg.2011.66-a
UL http://dx.doi.org/10.1001/archsurg.2011.66-a
AB 
An 83-year-old woman with a noncontributory surgical history presented with nearly 1 month of mild, intermittent right upper quadrant pain. She soon noticed a slowly growing mass in this area. She denied fever, chills, nausea, or a history of trauma. Physical examination revealed a fluctuant, palpable mass in the right upper quadrant with overlying erythema and mild tenderness to palpation (Figure, A). Laboratory values were significant for a white blood cell count of 13.4 million /μL (to convert to × 109/L, multiply by .001). Noncontrast abdominal computed tomography demonstrated a large hiatal hernia, small bilateral pleural effusions, and a right anterior abdominal wall subcutaneous lesion that was approximately 5 × 9 cm. In addition, there were multiple large gallstones within an edematous gallbladder with pericholecystic fat stranding (Figure, B). Surgical management was indicated.