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Unusual Cause of Nonopacification of the Gallbladder During Oral Cholecystography

Richard F. Rosenberg, MD
JAMA. 1980;244(1):71-72. doi:10.1001/jama.1980.03310010057035.
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History  An 88-year-old woman was admitted to the hospital because of a 27-kg weight loss during a one-year period and pain in the right upper quadrant and epigastrium. She denied dysphagia, vomiting, or melena. She complained of easy fatigability and malaise and had hypochromic normocytic anemia. A two-day oral cholecystogram resulted in nonvisualization of the gallbladder. On the second day, a chest roentgenogram was obtained and an upper gastrointestinal (GI) tract series was performed (Fig 1 and 2).

Diagnosis  Esophageal carcinoma causing total obstruction of the esophagus.

Comment  The arrows in Fig 1 point to the iopanoic acid tablets that are trapped in the esophagus. Figure 2 shows total obstruction of the midesophagus by a carcinoma. Note the excessive secretions and contrast material above the lesion. As a result of the obstruction, the iopanoic acid tablets never reached the small intestine to be broken down and then conjugated by the


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