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 organomegaly.
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 elevated.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
b. An abnormal cavity with air-fluid levels
c. Biliary ductal dilatation
d. Calcified gallbladder