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US Gallbladder

US TIPS

  • Always ask when the patient last ate (at least 4 hours of fasting is best)
  • Have the patient supine or try left lateral decubitus for a better sonographic window
  • Have the patient take varying levels of inspiration, especially if the GB is under the rib cage
  • Use the ABD preset on the GE machine
  • Start with 5 MHz curvilinear transducer
  • Don't be shy! really press down with the transducer and use lots of gel
  • One of the reasons the Sonographers get better images is that they press down harder than us
  • If you can't find the common bile duct, use a cine and scan throughout the gb slowly.  To get a cine, hit the record image button without pausing. This will record the past few seconds of scanning
  • When in doubt, don’t hesitate to recommend a HIDA



RUQ US PROTOCOL

  • Sagittal and transverse images of the gallbladder
  • NECK AND CBD
    • CBD < 6mm (+1 mm for each decade after 60)
    • Most common reason for an inadequate study on call is no CBD
    • Use color to differentiate vessels from ducts in the porta hepatis (both the CBD and hepatic artery have echogenic walls)
  • GB Wall Thickening
    • If the patient's body habitus allows, use the 9 MHz linear to measure anterior wall thickness in transverse
    • Should be 1-3 mm thick
    • "Double wall" sign may be GB wall edema
  • Pericholecystic fluid 
  • Look for stones
    • Place the focal zone at the stone to demonstrate shadowing
    • WES sign (Wall Echo Shadow): stones completely fill GB-completely obscures post wall
  • To differentiate adherent stones vs. polyps
    • Shake probe
    • Use color Doppler
    • Demonstrate shadowing
  • 1% of cholecystitis is acalculous 
  • Color doppler can demonstrate hyperemia in an inflamed gallbladder
  • Assess for and document a sonographic Murphy's sign
    • Max tenderness during compression w/ transducer directly on GB
    • False negative sonographic Murphy's sign
      • Lack of patient responsiveness
      • Pain medication
      • Diabetes
      • Inability to press directly on GB 
      • Position deep to liver/protected by ribs
      • GB wall necrosis
Saggital images of the GB


Transverse images of GB



On this sagittal image, the hepatic artery (HA) is anterior to the common duct (CD)

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RadRez Administrator,
Jul 9, 2013, 2:27 PM