n e w e ng l a n d j o u r na l
m e dic i n e
images in clinical medicine
Sriram Rajagopalan, M.R.C.S.Malcolm Loudon, F.R.C.S.
Aberdeen Royal Infirmary Aberdeen, Scotland firstname.lastname@example.org
n 83-year-old man with hypertension presented with a3-month history of a painful, progressively enlarging mass in the1st right subcostal reRETAKE AUTHOR Rajagopalan ICM 2nd gion. He reported no associateda&bconstitutional symptoms and no history of REG F FIGURE 3rd CASE TITLE abdominal surgery. Local examination revealed a tender,Revised erythematous, fluctuantEMail 4-C Line mass, 3 cm by 2 cm, with clinically significant surrounding induration and an underSIZE End ARTIST: mst H/T H/T lying fixed mass (Panel A).Computed tomography revealed28p the mass was comthat FILL Combo municating with a large gall bladder mass (Panel NOTE: B, arrow). Ultrasonography-guided AUTHOR,PLEASE Figure has been redrawn and type has been reset. needle biopsy, along with histologic and immunocytochemical examinations, conPlease check carefully.firmed that the mass was an adenocarcinoma of the gall bladder. The patient did not agree to any further JOB: 36208 or treatment. He was2-25-10 evaluationdischarged with plans for ISSUE: palliative care and died 5 weeks later.
Copyright © 2010 Massachusetts Medical Society.
n engl j med 362;8nejm.org
february 25, 2010
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