Case 1008
CholelithiasisWhat is the diagnosis?
Ultrasound
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Ultrasound of the gallbladder (arrow from the original source).
Image: James Heilman, MD, CC BY-SA 3.0 — sourceAnswer hidden. Review the images and history, decide on your diagnosis, then reveal.
Findings
- Echogenic structure within the dependent gallbladder lumen (arrow)
- Posterior acoustic shadowing behind it
- No gallbladder wall thickening or pericholecystic fluid on this image
Case discussion
An echogenic, shadowing, mobile focus in the gallbladder is a gallstone. Ultrasound is the first-line test and is highly accurate.
A polyp is attached to the wall, does not move and does not shadow. Features of acute cholecystitis — wall thickening, pericholecystic fluid and a sonographic Murphy sign — should be looked for in every patient with pain.