The wanderlust of a gallstone: a case report of intrathoracic migration of a gallstone post complicated cholecystectomy mimicking lung cancer

Abstract

Gallstones migrating into the right hemithorax post complicated cholecystectomy may be misdiagnosed for lung cancer, especially in the context of a distant history of cholecystectomy, poor recall of medical history and incomplete patient data. We present a case of a female patient with heavy smoking history who presented to our emergency department with haemoptysis and mild weight loss. Imaging workup showed an ¹⁸F-fludeoxyglucose positron emission tomography-positive heterogeneous nodule with central calcification in the right lower lobe, carrying lung cancer as a differential diagnosis. The resected specimen revealed an inflammatory pseudomass formed around a gallstone. This case illustrates the importance of knowing the spectrum of clinical and radiological presentation of a gallstone migrating into the right hemithorax, in order to prompt appropriate management and prevent misdiagnosis and mistreatment.

Figure 1.

Frontal chest X-ray demonstrating a right lower lobe ill-defined opacity (arrow).

Figure 2.

Axial contrast-enhanced CT scan of the chest in soft tissue window demonstrating a right lower lobe solid nodule (arrow) with central calcified focus.

Figure 3.

Axial non-contrast CT scan (a), FDG-PET scan (b), and fused PET/CT scan (c) showing focal increased FDG uptake within the right lower lobe nodule (arrows), maximum standardized uptake value of 5. FDG, ¹⁸F-fludeoxyglucose; PET, positron emission tomography.

Figure 4.

Axial contrast-enhanced CT scan of the abdomen demonstrating multiple spilt gallstones within Morison's pouch (arrows).

Figure 5.

Fresh unopened lung wedge resection with staple line at the surgical margin, there is a defect on one side of this (black arrow). Separately received off-white to brown rhomboid stone (white arrow).