Document Type : Case reports


1 Division of Nephrology, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Taiwan

2 Department of Life Science, Tunghai University, Taichung, Taiwan

3 Department of Medicine, National Yang-Ming University, Taipei, Taiwan

4 Department of Family Medicine, Cheng Ching General Hospital, Taichung, Taiwan


Background: Porcelain gallbladder is associated with a higher prevalence of malignancy. Prophylactic cholecystectomy is sug-
gested for both symptomatic and asymptomatic patients. Although gallstones are very commonly observed in clinical practices, it
is recommended in asymptomatic patients. However, a ring-shaped gallstone may be easily mistaken with porcelain gallstone and
requires further investigation using computed tomography (CT) to avoid the unnecessary risks of surgery.
Case Presentation: A 71-year-old female with renal dysfunction and diabetes mellitus had a ring-shaped calcification confirmed
by abdominal CT scan in Taichung city of Taiwan, in 2016. She had already been followed up for at least seven years. In addition
to traditional risk factors, authors believe that renal dysfunction may have also predisposed her to the development of a gallstone.
The differential diagnosis of porcelain gallbladder and only ring-shaped gallstone is very important due to different treatments and
outcomes. The more attractive part of this case was that the ring-shaped gallstone is rare in clinical practices.
Conclusions: For patients with a ring-shaped calcification, clinicians should rule out porcelain gallbladder since such a diagnosis
would indicate an increased risk of gallbladder carcinoma