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US Gallbladder


  • 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


  • Sagittal and transverse images of the gallbladder
    • 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)

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