A 38-year-old Hispanic female presented to the ED with complaints of epigastric abdominal pain. The pain was intermittent and usually worse after eating meals. She denied fever, nausea, and vomiting. She reported that she did have good appetite and had recently eaten a meal.
On physical exam, there was mild tenderness in the epigastrium.
Biliary colic was in the differential, and therefore, a bedside gallbladder ultrasound was completed in the ED.
Here are the images that were obtained:
The resident told me that the wall of the gallbladder was thickened and that there were gallstones. What do you think?
The resident thought that there were gallstones because he saw shadowing:
This was a great case for the resident because there were two great learning points about imaging the gallbladder:
- EDGE ARTIFACT produces shadowing on the edges of the gallbladder. This is not a pathologic finding. This is from the sound beam being refracted off the side of the gallbladder.
- A contracted gallbladder can have a non-pathologically thickened wall. Often times, a contracted gallbladder wall will look thick even though it is actually not. Measure the wall if you are not sure. This patients gallbladder was contracted because of her post-prandial state.
We went back and measured the gallbladder wall:
It measured slightly thickened (normal <0.3 cm).
This is a normal ultrasound of the gallbladder. The patient felt better with a GI cocktail, and was discharged home on an H2-blocker.