What is the diagnosis for a patient with a normal abdominal ultrasound?

From the Guidelines

The ultrasound results show a completely normal abdominal examination, indicating no evidence of disease and confirming the conclusion of a normal abdominal ultrasound. The liver is normal in size and texture without any concerning lesions. The gallbladder appears healthy with no stones. The bile ducts are not dilated, with the common bile duct (CBD) measuring a normal 3 mm. The pancreas looks normal with no surrounding fluid collection. The spleen size is within normal limits at 8 cm. The abdominal aorta measures a normal 1.3 cm, showing no evidence of aneurysm. Both kidneys are of normal size (right 11.5 cm, left 11.7 cm) with no signs of obstruction (hydronephrosis) or kidney stones. There is no free fluid in the abdomen (ascites). According to the American College of Radiology Appropriateness Criteria 1, ultrasound is the first choice of investigation for biliary symptoms or right upper quadrant abdominal pain, and a normal appearance of the gallbladder makes acute gallbladder pathology very unlikely. Given the normal ultrasound results, no further imaging or intervention is needed based on these results unless there are ongoing symptoms that warrant additional investigation. This approach is supported by the American College of Physicians guideline on the diagnosis and management of acute left-sided colonic diverticulitis 1, which suggests that clinicians use abdominal CT imaging when there is diagnostic uncertainty, but also considers the potential harms of CT imaging, such as radiation exposure and incidental findings. In this case, the normal ultrasound results provide sufficient evidence to confirm the absence of disease, and further imaging or intervention would not be necessary unless new symptoms arise.

From the Research

Abdominal Ultrasound Findings

• The liver is normal in size and echotexture with no focal lesions
• The gallbladder is thin-walled with no stones
• No dilated intrahepatic ducts, with a common bile duct (CBD) measuring 3 mm
• The pancreas appears normal with no fluid in the lesser sac
• The spleen measures 8 cm
• The abdominal aorta measures 1.3 cm
• The right kidney measures 11.5 cm and the left kidney measures 11.7 cm
• No hydronephrosis or renal calculi
• No ascites

Relevance of Ultrasound Findings

• According to 2, ultrasound is an effective first-line imaging modality for evaluating right upper quadrant pain and diagnosing gallstones and cholecystitis.
• The absence of gallstones and normal gallbladder appearance in the ultrasound findings suggest a low likelihood of acute cholecystitis, as described in 3.
• The normal appearance of the pancreas and absence of fluid in the lesser sac suggest a low likelihood of pancreatitis, as discussed in 4 and 5.
• The ultrasound findings are consistent with a normal abdominal ultrasound, as there are no indications of abnormalities in the liver, gallbladder, pancreas, spleen, kidneys, or abdominal aorta.

Diagnostic Approach

• As outlined in 6, the diagnostic approach for acute abdominal pain involves a combination of clinical evaluation, laboratory tests, and imaging studies.
• Ultrasound is a useful imaging modality for evaluating abdominal pain, particularly for right upper quadrant pain, as mentioned in 2 and 6.
• The absence of abnormal findings on the ultrasound suggests that further imaging or diagnostic tests may not be necessary, unless clinical symptoms or laboratory results indicate otherwise.