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Diagnostic Dilemma

Diagnostic Dilemma

A 72-year-old woman with chronic obstructive pulmonary disease (COPD)
presents with abnormal liver chemistries. She denies recent abdominal pain but
recalls "gallbladder problems" after childbirth approximately 40
years ago. She has not lost any weight and denies fever. There is no history of
nausea or vomiting.

Her past history is significant only for advanced COPD. There is no history
of hypertension or diabetes mellitus. Her medication use consists of
bronchodilators. There is no surgical history. Family history is positive for
heart and gallbladder disease. There is no family history of cancer.

Physical examination is significant for normal temperature and vital signs.
There is no evidence of jaundice or signs of chronic liver disease. Breath
sounds are diffusely decreased, and there is no abdominal tenderness, mass, or

Laboratory evaluation is pertinent for normal white blood cell count,
negative stool guaiac test, and normal bilirubin level. The alkaline
phosphatase level is elevated fourfold. Transaminase levels are only mildly

Workup includes an abdominal CT scan (left image). The CT scout film (right
image) demonstrates an ovoid calcification in the right upper quadrant.

1. The CT images reveal:

a. Multiple filling defects in the liver

An abnormal cavity with air-fluid levels
c. Biliary ductal dilatation
d. Calcified gallbladder
e. Cirrhosis


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