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A 90-year-old male with metastatic prostate cancer presented with hypoactive delirium. With no localising features, normal liver function tests but persistently raised inflammatory markers, he was initially managed as a urinary tract infection. Chest wall discomfort and swelling over the right costal margin later developed. Abdominal imaging demonstrated a massive gallbladder empyema invaginating through the lower right rib cage, causing the superficial swelling. Pre-morbid status prevented cholecystectomy and he was managed conservatively with percutaneous cholecystostomy and antibiotics. He was discharged to 24-h care 2\u00a0weeks after diagnosis with a long-term drain.<\/jats:p>","DOI":"10.1093\/ageing\/afab123","type":"journal-article","created":{"date-parts":[[2021,5,18]],"date-time":"2021-05-18T19:10:32Z","timestamp":1621365032000},"page":"1859-1860","source":"Crossref","is-referenced-by-count":3,"title":["Diagnostic complexity in the older patient: an unusual presentation of advanced biliary disease"],"prefix":"10.1093","volume":"50","author":[{"given":"Jennifer","family":"Hosty","sequence":"first","affiliation":[{"name":"Internal Medicine Trainees, Department of Geriatric Medicine, Doncaster Royal Infirmary, Doncaster DN2 5LT, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ruth","family":"Narramore","sequence":"additional","affiliation":[{"name":"Internal Medicine Trainees, Department of Geriatric Medicine, Doncaster Royal Infirmary, Doncaster DN2 5LT, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Matthew","family":"Boothroyd","sequence":"additional","affiliation":[{"name":"Internal Medicine Trainees, Department of Geriatric Medicine, Doncaster Royal Infirmary, Doncaster DN2 5LT, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Rekha","family":"Ramanath","sequence":"additional","affiliation":[{"name":"Consultant in Geriatric Medicine, Department of Geriatric Medicine, Doncaster Royal Infirmary, Doncaster DN2 5LT, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"286","published-online":{"date-parts":[[2021,6,18]]},"reference":[{"key":"2021091315215733100_ref1","doi-asserted-by":"crossref","first-page":"489","DOI":"10.1503\/cmaj.050051","article-title":"A global clinical measure of fitness and frailty in elderly people","volume":"173","author":"Rockwood","year":"2005","journal-title":"CMAJ"},{"key":"2021091315215733100_ref2","doi-asserted-by":"crossref","first-page":"561","DOI":"10.1177\/0269216310371556","article-title":"Single Question in Delirium (SQiD): testing its efficacy against psychiatrist interview, the Confusion Assessment Method and the Memorial Delirium Assessment Scale","volume":"24","author":"Sands","year":"2010","journal-title":"Palliat Med"},{"key":"2021091315215733100_ref3","doi-asserted-by":"crossref","first-page":"e923040-1","DOI":"10.12659\/AJCR.923040","article-title":"Uncommon presentation of severe empyema of the gallbaldder: case report and literature review","volume":"21","author":"Elkbuli","year":"2020","journal-title":"Am J Case Rep"},{"key":"2021091315215733100_ref4","doi-asserted-by":"crossref","first-page":"1149","DOI":"10.1001\/archsurg.1978.01370220035006","article-title":"Acute cholecystitis in the elderly: a surgical emergency","volume":"113","author":"Morrow","year":"1978","journal-title":"Arch Surg"}],"container-title":["Age and Ageing"],"original-title":[],"language":"en","link":[{"URL":"http:\/\/academic.oup.com\/ageing\/article-pdf\/50\/5\/1859\/40349054\/afab123.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"http:\/\/academic.oup.com\/ageing\/article-pdf\/50\/5\/1859\/40349054\/afab123.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2021,9,13]],"date-time":"2021-09-13T15:22:16Z","timestamp":1631546536000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/ageing\/article\/50\/5\/1859\/6304947"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,6,18]]},"references-count":4,"journal-issue":{"issue":"5","published-online":{"date-parts":[[2021,6,18]]},"published-print":{"date-parts":[[2021,9,11]]}},"URL":"https:\/\/doi.org\/10.1093\/ageing\/afab123","relation":{},"ISSN":["0002-0729","1468-2834"],"issn-type":[{"value":"0002-0729","type":"print"},{"value":"1468-2834","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2021,9]]},"published":{"date-parts":[[2021,6,18]]}}}