The presence of co-existing pulmonary tuberculosis, calcifications in the gallbladder wall, and calcific/necrotic lymph adenopathy all point to a diagnosis of tuberculosis. The differential diagnosis includes gallbladder malignancy or xantho-granulomatous cholecystitis. A recent review found only about 120 cases reported in world literature to date. Rarely, multi-cystic form has been described. Three main types of gallbladder tuberculosis are described: micro-nodular or polypoidal type, mural thickening type (most common, and may also present as halo due to peri-cholecystic oedema), and mass-forming type. Tuberculosis of the gallbladder is rare, and preoperative diagnosis of gallbladder tuberculosis is difficult. ![]() The patient underwent cholecystectomy with biopsy diagnostic of tuberculosis. The differential diagnoses considered included disseminated gallbladder malignancy and disseminated tuberculosis with gallbladder involvement (due to the young age of patient and calcified lymphadenopathy). A few nodes showed calcifications/central necrosis ( Figure 1). CT of the thorax revealed multiple air-space opacities in left upper lobe with mediastinal, hilar, para-aortic, and peri-pancreatic lymph adenopathy. Contrast-enhanced computed tomography (CECT) showed enlarged multi-cystic lesion replacing gallbladder with ascites, ‘omental caking’, and minimal recto-sigmoid colonic wall thickening. Ultrasound revealed enlarged gallbladder with wall thickening and mild ascites. ![]() A 24-year-old male presented with insidious abdominal pain and weight loss for 4 months.
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