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Differential Diagnoses for a 17-year-old with Elevated WBC, RUQ Pain, and Specific Imaging Findings

Single Most Likely Diagnosis

  • Chronic Cholecystitis: This condition is characterized by chronic inflammation of the gallbladder, which could explain the thickened gallbladder wall and contracted gallbladder seen on CT abdomen with contrast. The monthly recurrence of right upper quadrant (RUQ) pain coinciding with the menstrual period suggests a possible relationship with hormonal changes, and the elevated white blood cell (WBC) count indicates an inflammatory process.

Other Likely Diagnoses

  • Biliary Dyskinesia: This condition involves abnormal contraction and relaxation of the gallbladder and biliary ducts, which could lead to recurrent RUQ pain. Although the HIDA scan was negative, biliary dyskinesia might not always be detected by this method, especially if the gallbladder is contracted at the time of the scan.
  • Inflammatory Bowel Disease (IBD): Conditions like Crohn's disease or ulcerative colitis can cause elevated WBC counts and may involve the gallbladder, leading to thickening of the gallbladder wall. The RUQ pain could be related to IBD affecting the terminal ileum or due to associated conditions like primary sclerosing cholangitis.
  • Hormonally Influenced Gallbladder Dysfunction: Hormonal changes during the menstrual cycle can affect gallbladder function, potentially leading to recurrent pain and possibly influencing gallbladder wall thickness.

Do Not Miss Diagnoses

  • Gallbladder Cancer: Although rare, especially in a 17-year-old, gallbladder cancer can present with a thickened gallbladder wall and recurrent pain. It's crucial to consider this diagnosis due to its severe implications.
  • Sclerosing Cholangitis: Primary sclerosing cholangitis can cause thickening of the gallbladder wall and is associated with IBD. It's a serious condition that requires early diagnosis and management.
  • Infectious Cholecystitis: An infection of the gallbladder could explain the elevated WBC count and imaging findings. It's a condition that requires prompt treatment to avoid complications.

Rare Diagnoses

  • Porcelain Gallbladder: A condition where the gallbladder wall becomes calcified, which could be seen as thickening on imaging. It's associated with chronic inflammation and has a risk of gallbladder cancer.
  • Gallbladder Hydrops: A condition characterized by the gallbladder becoming distended with fluid, which might not be evident if the gallbladder is contracted at the time of imaging. It can be associated with various conditions, including infections and obstructions.

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Professional Medical Disclaimer

This information is intended for healthcare professionals. Any medical decision-making should rely on clinical judgment and independently verified information. The content provided herein does not replace professional discretion and should be considered supplementary to established clinical guidelines. Healthcare providers should verify all information against primary literature and current practice standards before application in patient care. Dr.Oracle assumes no liability for clinical decisions based on this content.

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