Ultrasonography of cholecystitis

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Author: Mikael Häggström [notes 1]
Ultrasonography of suspected cholecystitis.


Choice of modality

  • Right upper quadrant abdominal ultrasonography of cholecystitis is generally the first exam of choice.[1][2][3]
  • Abdominal CT may be used if complications such as perforation or gangrene are suspected.[4] In adults, acute abdominal symptoms that are rather unspecific also indicate CT.

How soon

After 8 hours of fasting in order to distend the gallbladder.[5]


Gallstones, wall thickening and pericholecystic fluid (dark crescent at the left upper gallbladder border).

Ultrasound findings suggestive of acute cholecystitis include:[6]

  • Gallstones. Further information: Ultrasonography of gallstones
  • Pericholecystic fluid
  • Gallbladder wall thickening (wall thickness over 3 mm)[7]
  • A sonographic Murphy's sign. A sonographic Murphy's sign which is where the patient experiences pain by pressure upon the gallbladder with the ultrasound probe in inspired state.[8][9]
Common bile duct diameter in adults[10]
Normal ≤ 8 mm
Mild dilatation 8 – 12 mm
Moderate dilatation 12 – 16 mm
Severe dilatation 16 – 20 mm
Extremely severe dilatation >20 mm
  • Dilation of the bile dicts. A dilated common bile duct is where it measures over 8 mm.[10] It is distinguished from the portal vein and hepatic artery by absence of flow on Doppler.

It is also appropriate to perform a general upper abdominal screening.


  1. For a full list of contributors, see article history. Creators of images are attributed at the image description pages, seen by clicking on the images. See Radlines:Authorship for details.


  1. Strasberg, SM (26 June 2008). "Clinical practice. Acute calculous cholecystitis. ". The New England Journal of Medicine 358 (26): 2804–11. doi:10.1056/nejmcp0800929. PMID 18579815. 
  2. "Revised estimates of diagnostic test sensitivity and specificity in suspected biliary tract disease ". Arch. Intern. Med. 154 (22): 2573–81. November 1994. doi:10.1001/archinte.154.22.2573. PMID 7979854. 
  3. "The sensitivity of hepatobiliary imaging and real-time ultrasonography in the detection of acute cholecystitis ". Arch Surg 120 (8): 904–6. August 1985. doi:10.1001/archsurg.1985.01390320028004. PMID 3893388. 
  4. Friedman L.S. (2015). Liver, Biliary Tract, & Pancreas Disorders. In Papadakis M.A., McPhee S.J., Rabow M.W. (Eds), Current Medical Diagnosis & Treatment 2015
  5. Alan A Bloom. Cholecystitis Workup. medscape. Updated: Nov 08, 2017
  6. Greenberger N.J., Paumgartner G (2012). Chapter 311. Diseases of the Gallbladder and Bile Ducts. In Longo D.L., Fauci A.S., Kasper D.L., Hauser S.L., Jameson J, Loscalzo J (Eds), Harrison's Principles of Internal Medicine, 18e
  7. van Breda Vriesman, Adriaan C.; Engelbrecht, Marc R.; Smithuis, Robin H. M.; Puylaert, Julien B. C. M. (2007). "Diffuse Gallbladder Wall Thickening: Differential Diagnosis ". American Journal of Roentgenology 188 (2): 495–501. doi:10.2214/AJR.05.1712. ISSN 0361-803X. 
  8. Urbano FL and Carroll M, Hospital Physician, November 2000: p51-52 (includes a description of the Murphy sign, and an erroneous description of the sonographic Murphy sign)
  9. Orient JM, Sapira's Art & Science of Bedside Diagnosis 3e, 2005, Lippincott Williams & Wilkins, p461 (describes one method in detail for eliciting the Murphy sign)
  10. 10.0 10.1 Yunfu Lv, Wan Yee Lau, Haiying Wu, Shunwu Chang, NingLiu, Yejuan Li, Jie Deng (2015). "Etiological Causes of Intrahepatic and Extrahepatic Bile Duct Dilatation ". International Journal of New Technology and Research (IJNTR) 1 (8). Archived from the original. .