Intended for healthcare professionals

Endgames Picture Quiz

A man with intra-abdominal calcification

BMJ 2011; 343 doi: (Published 14 September 2011) Cite this as: BMJ 2011;343:d5322
  1. A Shaw, specialist registrar in radiology,
  2. B Smith, specialist registrar in radiology,
  3. C Inglis, foundation year 2 doctor,
  4. D Howlett, consultant radiologist
  1. 1Eastbourne District General Hospital, East Sussex Hospitals Trust, Eastbourne BN21 2UD, UK
  1. Correspondence to: A Shaw aidanshaw1{at}

A 66 year old man presented to the accident and emergency department with a history of longstanding upper abdominal pain. The pain was of acute onset, located in the right upper quadrant, did not radiate, was associated with nausea and bloating, and had started after a meal of fried food. He had no history of foreign travel. Apart from hypertension, he had no relevant medical history.

On examination he was not jaundiced and his abdomen was soft with tenderness in the right upper quadrant. Murphy’s sign was positive. Plain abdominal radiography was performed (fig 1).

Fig 1 Plain abdominal radiograph


  • 1 What are the radiological findings and what is the likely diagnosis?

  • 2 What further imaging could you perform to confirm the diagnosis?

  • 3 Does this condition have any associations and how should it be managed?


1 What are the radiological findings and what is the likely diagnosis?

Short answer

The abdominal radiograph shows a soft tissue density in the right upper quadrant with thin curvilinear calcification outlining the wall. The diagnosis is a porcelain gallbladder.

Long answer

Porcelain …

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