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The patient was admitted for stent exchange after seven months (he missed the three month appointment). He was doing well, except for occasional burning right abdominal pain, with a net weight gain of 9 kg. There were no abnormal laboratory findings. On endoscopic retrograde cholangiography, no stents were detected and no remaining stricture of the bile duct could be seen. Repeated biopsies showed only regular bile duct epithelium. Abdominal ultrasound revealed a contracted gall bladder with persistent wall thickening and absence of cholestasis. [18F]fluoro-2-deoxy-D-glucose-positron emission tomography (FDG-PET) showed marked remission with only minimal residual local activity enhancement (fig 1E). The case was reviewed, and retrospectively, chronic cholecystitis with subsequent pericholecystitis, due to Mirizzi syndrome, was considered the most likely diagnosis. The patient was considered eligible for cholecystectomy but refused surgery. Two years after the first admission the patient is doing well without signs of a malignant disease. Despite all modern imaging techniques, Mirizzi syndrome can still be a clinical chameleon.

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