Ultrasonography of gallstones

Author: Mikael Häggström

Planning

Choice of modality

• Ultrasonography of gallstones is the investigation of choice. In suspected cholecystitis such as severe and constant pain, see Ultrasonography of cholecystitis.

How soon

• Within a couple of hours if any of the following:

• Atypical symptoms (which may indicate a more serious disease of the biliary tract or abdomen)
• Pain that does not subside on analgesics.
• Suspected pancreatitis. See: Ultrasonography of pancreatitis

• Otherwise, generally 4-8 weeks in Swedish practice.

Evaluation

• Gallbladder: Gallstones are seen as hyperechoic objects, that leave an acoustic shadow. In case of similarity to a polyp (Ultrasonography of gallbladder polyps), turn the patient, making gallstones changing position, while polyps remain in the same place.
• Related structures: Also exclude signs of cholecystitis, mainly pericholecystic fluid, gallbladder wall thickening, dilation of the bile duct (see below), and a sonographic Murphy's sign. Further information: Ultrasonography of cholecystitis.

• A dilated common bile duct is where it measures over 8 mm. It is distinguished from the portal vein and hepatic artery by absence of flow on Doppler. Further information: Ultrasonography of dilated bile ducts

• 

  In case of a dilated bile duct, an attempt can be made to follow it to detect visible gallstones therein, such as in this case.

• Other: It is also proper practice to perform a general upper abdominal screening.