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Abstract

).With the advancement of imaging modalities, plain film radiology is increasingly overlooked. However, its importance cannot be denied in investigating acute abdominal conditions and diagnosing various causes of calcifications, which can be pathognomonic of certain chronic abdominal diseases. Although plain abdominal radiographs are often diagnostic in depicting majority of renal stones and calcifications of blood vessels and lymph nodes, these rarely demonstrate gallbladder (GB) stones and its mural calcification.Porcelain GB is a complete or partial calcification of the entire GB wall thickness or its mucosal layer that is visualized on plain abdominal X-ray as a thin curvilinear or speckled calcification in right upper quadrant (RUQ) or more precisely the gallbladder fossa. It is often associated with gallstones, which are usually radiolucent. Ultrasound scan (USS) can demonstrate an echogenic thick shadowing in the GB fossa making it difficult to differentiate from emphysematous cholecystitis. Computed tomography (CT) scan with threedimensional (3-D) reconstruction is considered highly efficient in diagnosing this condition. Case ReportsWe present three cases of porcelain GB with abdominal pain. The first case was a middle-aged Mediterranean male patient who presented with intermittent postprandial pain on several occasions in A&E. His plain abdominal film revealed a faint thin curvilinear calcification in RUQ. Subsequently, he had an abdominal CT scan that confirmed the diagnosis of porcelain GB by demonstrating a heavily calcified neck and body of the GB. Keywords► porcelain gallbladder ► cancer ► diagnosis ► mural calcification AbstractBackground Porcelain gallbladder (GB) is a rare but potentially premalignant condition with minimal symptoms. Accident and Emergency (A&E) departments often tend to investigate abdominal pain through plain radiographs, which are occasionally reported by radiologists, thereby leaving behind few uncommon conditions, such as porcelain gallbladder unreported. Objectives We present three cases of porcelain GB in which initial diagnosis was not considered due to the presence of various other calcifications in the upper abdomen. Methods In A&E, plain abdominal X-rays were routinely performed in all three patients to investigate nonspecific postprandial abdominal pain. Although GB calcification was easy to diagnose on plain films, it was initially overlooked to be a cause of the symptoms and later was diagnosed on abdominal CT scans, performed for further evaluation. Results Abdominal X-rays revealed thin curvilinear calcification in the GB wall, partially calcified neck and body, and gall stones. CTscan confirmed porcelain GB in all three patients. Conclusion Gallbladder mural calcification is a rare cause of nonspecific abdominal pain, which is often overlooked on plain abdominal X-rays causing missed diagnosis. The association of porcelain GB with adenocarcinoma entails special emphasis on timely diagnosis and prompt management.