Case from Ultrasound of the Week: UOTW #30

64 yo female presents to the emergency department with periumbilical pain that was first noted yesterday after a meal. The pain subsequently moved to the RLQ. Patient has had intermittent vomiting since the pain started. Non bilious, non-bloody.  Reports a few episodes similar to this one in the previous months, but states that this episode hurts much worse.  The following evaluation began in the right lower quadrant:

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What to Know
  1. List indications, contraindications, and limitations of biliary CUS.
  2. Identify clinically relevant sonographic anatomy of the hepatobiliary system.
  3. Perform the CUS protocols when required.
  4. Recognize relevant CUS findings and pitfalls when evaluating for cholelithiasis and cholecystitis.

Introduction to Bedside Ultrasound
Free iBook download Vol 1 and Vol 2
Right Upper Quadrant
Self Assessment Quiz

US Podcasts

Gall Bladder Ultrasound 9/9/2012

ACEP US Section Resources
ACEP Sonoguide Gall Bladder Page by Christian Fox and William Scruggs

SAEM Academy of EUS Resources
Emergency US of the Biliary Tract by Joseph Mindardi

Key Articles

  1. ACEP Emergency Ultrasound Guidelines 2016
  2. Summers SM, Scruggs W, Menchine MD, et al. A Prospective Evaluation of Emergency Department Bedside Ultrasonography for the Detection of Acute Cholecystitis. Ann Emerg Med. 2010;56(2):114–122.
  3. Jang TB, Ruggeri W, Dyne P, Kaji AH. The Learning Curve of Resident Physicians Using Emergency Ultrasonography for Cholelithiasis and Cholecystitis. Acad Emerg Med. 2010;17(11):1247–1252.
  4. Becker B a, Chin E, Mervis E, Anderson CL, Oshita MH, Fox JC. Emergency Biliary Sonography: Utility of Common Bile Duct Measurement in the Diagnosis of Cholecystitis and Choledocholithiasis. J Emerg Med. 2013;(March):1-7.