Emergency Radiology

, Volume 22, Issue 4, pp 445–447 | Cite as

The cystic duct knot sign: case report with description of a new ultrasound sign of gallbladder torsion

  • Anil K. DasyamEmail author
  • Julie Koo
  • Margaret Stahlfeld Miller
  • Harry W. SellJr.
  • Mitchell E. Tublin
Case Report


Gallbladder torsion or volvulus is a rare but potentially lethal entity. We report the imaging findings of gallbladder torsion and describe a potentially novel ultrasound sign for the preoperative diagnosis of torsion. An 87-year-old woman presented with a 4-day history of right upper quadrant pain. An initial right upper quadrant ultrasound exam demonstrated cholelithiasis and findings of acute cholecystitis which included gallbladder distension, wall thickening, trace pericholecystic fluid, and a positive sonographic Murphy’s sign. Gallbladder torsion was prospectively diagnosed on the subsequent contrast-enhanced CT scan of the abdomen based upon the abnormal transverse orientation of the gallbladder with the neck directed laterally. Ultrasound images were reviewed and a “knot”-like hyperechoic nodular appearance of the torsed cystic duct close to the gallbladder neck was clearly apparent. Prospective identification of the torsed cystic duct may prompt the ultrasound diagnosis of gallbladder torsion.


Gallbladder Torsion Volvulus Ultrasound Cystic duct Knot sign 


Conflict of interest

The authors declare that they have no conflict of interest.

Supplementary material

10140_2015_1331_MOESM1_ESM.avi (54.9 mb)
Fig. 4 Ultrasound cine images of the gallbladder in its long axis demonstrate gallbladder wall thickening and shadowing intraluminal calculus. The cystic duct can be seen entering and exiting the echogenic nodule at the gallbladder neck which constitutes the “cystic duct knot” sign (avi 56215 kb)


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Copyright information

© American Society of Emergency Radiology 2015

Authors and Affiliations

  • Anil K. Dasyam
    • 1
    Email author
  • Julie Koo
    • 1
  • Margaret Stahlfeld Miller
    • 1
  • Harry W. SellJr.
    • 2
  • Mitchell E. Tublin
    • 1
  1. 1.Department of RadiologyUniversity of Pittsburgh School of Medicine and Medical CenterPittsburghUSA
  2. 2.Department of SurgeryUniversity of Pittsburgh School of Medicine and Medical CenterPittsburghUSA

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