images in clinical medicine
The new england journal of medicine
n engl j med 364;20 nejm.org may 19, 2011
dice, fever, or weight loss. The results of laboratory investigations, including mea-
surement of liver enzymes, were unremarkable. Findings on abdominal ultrasonog-
raphy were abnormal, and subsequent magnetic resonance imaging of the abdomen
revealed a markedly distended gallbladder (Panel A, axial image, arrow; Panel B,
coronal reconstruction, arrow), measuring 17 cm by 8 cm, but no evidence of gall-
stones, extrinsic compression of the biliary tree, or biliary duct dilatation. A laparo-
scopic cholecystectomy was performed, and intraoperative aspiration of colorless
mucus from the gallbladder led to a diagnosis of hydropic gallbladder. In adults,
a hydropic gallbladder is usually a consequence of chronic obstruction (resulting
from gallstones or tumors) or narrowing (resulting from a congenital or fibrotic
condition or extrinsic compression) of the cystic duct. Cholecystectomy is the defini-
tive treatment. This patient’s symptoms resolved after surgery, and she remained
asymptomatic at follow-up 1 year later.
Copyright © 2011 Massachusetts Medical Society.
31-year-old woman presented with a 10-year history of mild,
episodic abdominal pain in the right upper quadrant and a palpable, slowly
growing mass in the right side of the abdomen. She had no history of jaun-
André Brito Queiroz, M.D.
Jocielle Santos de Miranda, M.D.
Hospital das Clinicas da Universidade
de São Paulo
São Paulo, Brazil
The New England Journal of Medicine
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Copyright © 2011 Massachusetts Medical Society. All rights reserved.