A 55-year-old woman with no significant medical history was admitted to hospital with a 3-day episode of severe pain in the right upper abdominal quadrant. She denied any postprandial pain. For 2 months she had been treated for an upper respiratory tract infection with cough by a local general practitioner.
On examination there was a vague tender mass in the right upper quadrant. There was no rebound tenderness. She was afebrile and her leukocyte count was 14 × 109/L. Her hemoglobin level was 117 g/L and results of liver function tests were normal. Ultrasonography of the biliary tree was suboptimal because of numerous bowel gas shadows. Magnetic resonance imaging of the upper abdomen was done (Figs. 1 and 2).
What would be your diagnosis?
For the answer and discussion see page 306.
Footnotes
Section Editor: Lawrence A. Stein, MD
Submissions to Radiology for the Surgeon, soft-tissue section, should be sent to Dr. Lawrence A. Stein, Department of Radiology, Royal Victoria Hospital, 687 Pine Ave. W, Montreal QC H3A 1A1.