Test Yourself

Case 2

HISTORY

A 40 year old woman presents with intermittent right upper quadrant pain.

ULTRASOUND FINDINGS

Clinical: There are numerous small gallstones in the gall bladder but no evidence of cholecystiits.

Radiology: There are numerous small, echogenic, shadowing, dependent foci within the gall bladder. There is no gall bladder wall thickening, no pericholecystic fluid, no hypervascularity of the gall bladder wall and no pericholecystic fluid.

DISCUSSION

Right upper quadrant pain is a frequent presentation to the emergency department. There is a broad differential and the clinician's approach and reliance on ultrasound will depend on their clinical suspicion and ultrasound expertise.

At a very basic level a look at the gall bladder may confirm stones or evidence of cholecystitis, and reviewing the kidney can detect the presence of hydronephrosis. Ensuring no aortic aneurysm would also be included at this level.

More advanced sonographers would examine the pancreas, aorta, bile ducts and gall bladder, liver, Morrison's pouch, posterior costophrenic recess, kidney and psoas. They would also examine the anterior abdominal wall if there was suspicion of hernias or rectus sheath collection. Bowel pathology can also be detected by ultrasound.

SUBMITTED BY

James Rippey


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Gall stones

Longitudinal view through gall bladder
Gall stones Gall stones