What are the findings of a normal abdominal ultrasound with normal liver, gallbladder, pancreas, spleen, abdominal aorta, and kidneys?

From the Guidelines

The ultrasound findings indicate a completely normal abdominal examination, with no evidence of disease, inflammation, obstruction, or abnormal growths, and therefore, no further imaging or intervention is needed based on these results. The liver has a normal size and texture without any lesions, and the gallbladder appears healthy with no stones present. The bile ducts are not dilated, with the common bile duct measuring a normal 3 mm, which is consistent with the findings of 1 that ultrasound is useful as a first-line investigation tool for mild increase in liver enzymes. The pancreas appears normal with no surrounding fluid collection. The spleen size is normal at 8 cm, and the abdominal aorta measures a normal 1.3 cm in diameter. Both kidneys are of normal size (right 11.5 cm, left 11.7 cm) with no evidence of hydronephrosis (fluid backup) or kidney stones. There is no free fluid in the abdomen (ascites).

According to 1, ultrasound is recommended as the initial diagnostic test of choice in patients with suspected obstruction of the common duct, and in this case, the normal caliber of the common bile duct measuring 3 mm has a high negative predictive value for choledocholithiasis. The findings of this ultrasound examination are consistent with a normal abdominal ultrasound examination, and therefore, no further imaging or intervention is needed based on these results.

Some key points to consider in this examination include:

• The liver echotexture is normal, which is consistent with the findings of 1 that normal liver shows echogenicity similar to or just higher than normal renal cortex.
• The gallbladder is thin-walled and stone-free, which reduces the risk of choledocholithiasis.
• The pancreas appears normal, with no surrounding fluid collection, which reduces the risk of pancreatic disease.
• The spleen size is normal, which reduces the risk of splenomegaly-related diseases.
• The abdominal aorta measures a normal 1.3 cm in diameter, which reduces the risk of aortic disease.
• Both kidneys are of normal size, with no evidence of hydronephrosis or kidney stones, which reduces the risk of renal disease.

From the Research

Ultrasound Findings

• The liver is normal in size and echotexture with no focal lesions, which is consistent with a normal ultrasound finding 2.
• The thin-walled gallbladder with no stones is also a normal finding, as gallstones are a common abnormality detected by upper abdominal ultrasound, observed in 141 patients (4.2%) in one study 3.
• The absence of dilated intrahepatic ducts and a normal common bile duct (CBD) measurement of 3 mm is consistent with a normal biliary tree 2.
• The normal appearance of the pancreas with no fluid in the lesser sac is also a normal finding, as pancreatic pathology can be evaluated using ultrasound in critically ill patients 2.
• The spleen size of 8 cm is within normal limits, and the absence of any splenic pathology is consistent with a normal ultrasound finding 2.
• The abdominal aorta measurement of 1.3 cm is within normal limits, and the absence of any aortic pathology is consistent with a normal ultrasound finding.
• The right and left kidney measurements of 11.5 cm and 11.7 cm, respectively, are within normal limits, and the absence of hydronephrosis or renal calculi is consistent with a normal ultrasound finding 3.
• The absence of ascites is also a normal finding, as ascites can be detected using ultrasound in critically ill patients 2.

Comparison to Studies

• A study on the frequency of abnormalities detected by upper abdominal ultrasound found that 52.4% of patients had positive findings, with fatty liver being the most common abnormality 3.
• Another study on the appropriateness of computed tomography and ultrasound for abdominal complaints in the emergency department found that 84.4% of ultrasound orders were inappropriate, highlighting the importance of proper ultrasound ordering and interpretation 4.
• A study on abdominal ultrasound as a diagnostic tool within the reach of general practitioners found that trained general practitioners can perform low-complexity ultrasound examinations of the abdomen with diagnostic competence, with a high level of agreement with radiologists 5.