Clinical Presentation

A 13-year-old girl with right upper quadrant abdominal pain.

Further Work-up

(A) An abdominal radiograph demonstrates a metallic belly button ring overlying the umbilicus. In the right upper quadrant are two round, calcific densities, likely representing gallstones (arrow). (B,C) Transverse and longitudinal sonograms of the right upper quadrant demonstrate round, echogenic, shadowing foci in the gallbladder lumen (arrows), consistent with gallstones. There is no gallbladder wall thickening, pericholecystic fluid, or other evidence of acute cholecystitis.

Differential Diagnosis

• Cholelithiasis: