Differential Diagnosis

The patient's presentation of long-standing gallstones, recent abdominal pain, nausea, vomiting, indigestion, general weakness, loss of appetite, weight loss, jaundice, and specific imaging findings leads to the following differential diagnoses:

• Single Most Likely Diagnosis

  • Gallbladder Adenocarcinoma: This is the most likely diagnosis given the patient's long history of gallstones, recent onset of systemic symptoms such as weight loss and jaundice, and imaging findings of a distended gallbladder with wall calcification, hepatomegaly, and the presence of hepatoduodenal lymph nodes with peritoneal nodules. Gallbladder adenocarcinoma is known to be associated with chronic gallstone disease and can present with non-specific symptoms until late stages.

• Other Likely Diagnoses

  • Pancreatic Head Cancer: Although the MRCP did not show any filling defects in the common bile duct, pancreatic head cancer could still be considered given the patient's jaundice and weight loss. However, the specific findings related to the gallbladder and the absence of CBD stones or filling defects make this less likely.
  • Klatskin Tumour: This is a type of cholangiocarcinoma that occurs at the junction of the right and left hepatic ducts. While it could explain the jaundice, the imaging findings and clinical presentation are more suggestive of a primary gallbladder pathology rather than a bile duct tumor.

• Do Not Miss Diagnoses

  • Acute Emphysematous Cholecystitis: Although the patient's presentation does not strongly suggest an acute infectious process, emphysematous cholecystitis is a life-threatening condition that requires prompt diagnosis and treatment. The presence of gallstones and a distended gallbladder could be risk factors, but the clinical context and imaging findings do not primarily point towards this diagnosis.
  • Metastatic Disease to the Liver: Given the patient's weight loss, jaundice, and hepatomegaly, metastatic disease to the liver from another primary site should be considered, although the specific findings related to the gallbladder suggest a primary gallbladder pathology.

• Rare Diagnoses

  • Xanthogranulomatous Cholecystitis: This is a rare form of chronic cholecystitis that can mimic gallbladder cancer in its presentation and imaging findings. It is characterized by a thickened gallbladder wall and can be associated with gallstones.
  • Porcelain Gallbladder with Associated Cancer: The presence of wall calcification in the gallbladder (porcelain gallbladder) is a rare condition that has been associated with an increased risk of gallbladder cancer. This diagnosis would align with the patient's long-standing gallstone disease and recent onset of systemic symptoms.