A middle aged woman was investigated for right sided abdominal pain and fevers. She had a past history of rheumatoid arthritis and was on long term steroids. An abdominal ultrasound was ordered to look for the source of her fever.
Multiple echogenic masses which demonstrated shadowing were seen in the gallbladder, consistent with multiple gallstones. The gallbladder wall is not thickened and there is no pericholecystic fluid. The transverse gallbladder images also demonstrate a gallbladder polyp on the superior wall. The patient did not describe any tenderness to probe pressure on the gallbladder (sonographic Murphy's sign absent).
The common bile duct is normal caliber.
Examination of the rest of the abdomen revealed the source of her fever (see Case)
Multiple small gallstones without evidence of cholecystitis.