Biliary Ultrasound

  • Angela B. CredittEmail author
  • Jordan Tozer
  • Michael Joyce


Abdominal pain is one of the most common ailments among patients within all facets of medicine. Right upper quadrant pain and its associated pathology, such as cholecystitis and cholelithiasis, can occur in patients seeing their primary care physician, seeking care in the emergency department, and in those admitted to the intensive care unit, general floor, or long term care facilities. Ultrasound is an efficient, easy, and economical modality for a provider to evaluate the gallbladder and its surrounding structures for disease processes. This chapter will focus on performing a biliary ultrasound, basic gallbladder and biliary system anatomy, image acquisition, and interpretation of pathology.


Cholelithiasis Sludge Cholecystitis Gallbladder polyp Choledocholithiasis 

Supplementary material

Video 8.1

Gallbladder in long axis: Gallbladder imaged in long axis (MP4 1924 kb)

Video 8.2

Gallbladder in short axis: Gallbladder imaged in short axis (MP4 1712 kb)

Video 8.3

Common bile duct: Common bile duct lies anterior to the thick-walled portal vein (MP4 1929 kb)

Video 8.4

Color Doppler flow over portal triad: With color Doppler, the common bile duct will not have any flow as opposed to the surrounding vessels (MP4 1938 kb)

Video 8.5

Large gallstone: Large gallstone with posterior acoustic shadowing (MP4 1761 kb)

Video 8.6

Multiple gallstones: Multiple gallstones with posterior acoustic shadowing (MP4 1873 kb)

Video 8.7

Wall echo shadow sign: Wall echo sign is seen when the gallbladder is contracted around many small stones or a single large stone (MP4 1921 kb)

Video 8.8

Biliary sludge: Sludge appears as hyperechoic fluid layering in the dependent portions of the gallbladder, without posterior shadowing (MP4 1798 kb)

Video 8.9

Acute cholecystitis: Gallbladder containing multiple stones and a thickened gallbladder wall suggestive of acute cholecystitis (MP4 2002 kb)

Video 8.10

Pericholecystic fluid: Pericholecystic fluid will be visualized as anechoic or hypoechoic fluid that surrounds the gallbladder, typically secondary to inflammation (MP4 1856 kb)

Video 8.11

Acalculous cholecystitis: Gallbladder with a thickened wall in the absence of gallstones (MP4 2273 kb)

Video 8.12

Choledocholithiasis: A stone is visualized within the common bile duct (MP4 2686 kb)


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Copyright information

© Springer International Publishing AG 2018

Authors and Affiliations

  • Angela B. Creditt
    • 1
    Email author
  • Jordan Tozer
    • 1
  • Michael Joyce
    • 1
  1. 1.Department of Emergency MedicineVirginia Commonwealth University Medical CenterRichmondUSA

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