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Clinical Summary

Biliary ultrasound can be very rewarding. A rapid, focused exam can help determine if gallstones or gallbladder pathology is the etiology of a patient’s presenting symptoms. In turn, bedside ultrasound can expedite therapy or expedite the pursuit of an alternative diagnosis. While the sonographic identification of gallstones may seem straightforward, the sonographic findings for cholecystitis are often subtle.

Indications

  • RUQ pain

  • Jaundice

  • Epigastric pain

Views for Emergency Department Biliary Ultrasound

  • Sagittal view of the gallbladder

  • Transverse view of the gallbladder

Equipment: Recommended Transducers for Gallbladder Ultrasound

  • Convex array

  • Phased array

Patient Positioning

  • Supine or left lateral decubitus position

Techniques

Sagittal View

  • Initially, the transducer is placed in the subxiphoid region with the indicator directed toward the patient’s head in a sagittal view and swept below the right costal margin to approximately the midclavicular line. The transducer is then rotated (often clockwise) to obtain a view of the gallbladder in its longest axis (Fig. 24.72).

  • Scan through the gallbladder completely from medial to lateral borders including careful evaluation of the gallbladder neck. A thorough search for gallstones should be made, particularly at the neck where small symptomatic gallstones may be seen.

  • Identify the liver, gallbladder, portal vein, hepatic artery, main lobar fissure, and the common hepatic duct (Figs. 24.73 and 24.75).

FIGURE 24.72

Gallbladder: Sagittal View. Probe is placed just under the costal margin and swept across the costal margin to locate the gallbladder. The transducer is then rotated (often clockwise) to obtain a view of the gallbladder in its longest axis. (Photo contributor: Lawrence B. Stack, MD.)

FIGURE 24.73

Gallbladder: Sagittal View. Long-axis view of gallbladder often reveals an “exclamation mark” sign made of the gallbladder and the portal triad. (Ultrasound contributor: Robinson M. Ferre, MD.)

FIGURE 24.74

Gallbladder: Transverse. Rotate the probe 90 degrees counterclockwise to bring the gallbladder into short axis. (Photo contributor: Lawrence B. Stack, MD.)

FIGURE 24.75

Gallbladder: Portal Triad. The portal vein (PV), hepatic artery, and common bile duct (CBD) are readily seen in the transverse view. (Ultrasound contributor: Shannon Snyder, MD, RDMS.)

Vedio Graphic Jump Location
Video 24-34: Gallbladder Gallstones
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