Paciente de 70 años de edad sin antecedentes de interés, acude a urgencias aquejado de pérdida ponderal de 15 kg, astenia intensa, anorexia y estreñimiento desde hace 2 meses. En el transcurso de la última semana presenta además, importante dolor cólico en hemiabdomen izquierdo con escasa mejoría a analgésicos habituales. En la exploración física destaca aceptable estado general, palidez mucocutánea, auscultación cardiorrespiratoria sin alteraciones y abdomen blando y depresible con dolor a la palpación profunda, así como palpación de masa de 5-6 cm de diámetro en cuadrante inferior izdo. En la analítica de ingre
A 65-year-old woman with no medical history of interest was attended in our outpatient Gastrointestinal Clinic because of a persistent pain in the right upper quadrant of the abdomen for several days. Physical examination was normal. Hemogram, coagulation tests and blood biochemistry-including transaminases and alkaline phosphatase-did not show meaningful alterations. An abdominal ultrasound was performed in which a pediculous polypoid mass of approximately 2 cm in size, without posterior shading, was detected in the gallbladder. A color power Doppler identified an arterial vessel within the polyp (Fig. 1). A cholecystectomy was performed and histology revealed an adenomatous polyp. The presence of a mass within the gallbladder is a relatively infrequent finding, and a malignancy should be excluded. Gallbladder adenomas are clinically and ultrasonographicaly similar to other polypoid masses. They represent only 4% of all gallbladder polyps. However, its malignant potential determines the clinical and diagnostic steps to be taken in patients with this incidental finding (1). The therapeutic strategy can be summarized as follows (1): a) all polyps larger than or equal to 1 cm in size represent an indication for cholecystectomy, as they may possibly be adenomas; b) gallbladder polyps smaller than 1 cm in asymptomatic patients require a (mid) yearly follow-up using ultrasounds; cholecystectomy should be performed if they grow to a size > 1 cm during follow-up; and c) in case of biliary symptoms and/or cholelithiasis an indication for cholecystectomy exists, regardless of size. At the present time, ultrasonography is without doubt the technique of choice in the study of the biliary system (1), as it has a high sensitivity and specificity in detecting the majority of intra-as well as extra-hepatic biliary diseases. However, the introduction of color Doppler systems has significantly improved the study of gallbladder conditions. Color Doppler ultrasonography can be used in the diagnosis of gallbladder masses simultaneously with conventional ultrasonography, and is extremely useful to differentiate between cancers and benign lesions (2). Some investigators try to differentiate between benign and malignant lesions by means of the vascularization pattern obtained by color Doppler ultrasonography. The absence of blood flow in a mass is known to be suggestive of a metastatic lesion. In addition, the presence of a signal of high blood flow within gallbladder masses or within the gallbladder wall is highly suggestive of primary cancer. A low blood flow suggests a benign lesion (2-5).
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.