Differential Diagnosis for Positive Murphy's Sign and Normal Gallbladder
- Single most likely diagnosis
- Cholecystitis: A positive Murphy's sign is highly suggestive of cholecystitis, even if the gallbladder appears normal on initial imaging. The sign indicates inflammation of the gallbladder, which may not always be visible on imaging, especially in early stages.
- Other Likely diagnoses
- Hepatitis: Inflammation of the liver can cause pain in the right upper quadrant, similar to cholecystitis, and may result in a positive Murphy's sign due to the proximity of the liver to the gallbladder.
- Peptic ulcer disease: Although less common, a peptic ulcer can cause referred pain to the right upper quadrant and potentially a positive Murphy's sign if the ulcer is located near the gallbladder.
- Do Not Miss (ddxs that may not be likely, but would be deadly if missed.)
- Perforated viscus: A perforation in the gastrointestinal tract can lead to peritonitis, which may cause a positive Murphy's sign due to the spread of inflammation. This condition is life-threatening and requires immediate surgical intervention.
- Liver abscess: An abscess in the liver can cause severe pain and may result in a positive Murphy's sign. If left untreated, liver abscesses can lead to sepsis and death.
- Rare diagnoses
- Right lower lobe pneumonia: In rare cases, pneumonia affecting the right lower lobe of the lung can cause referred pain to the right upper quadrant and potentially a positive Murphy's sign due to the proximity of the diaphragm to the gallbladder.
- Intestinal obstruction: Obstruction of the small or large intestine can cause severe abdominal pain and may result in a positive Murphy's sign if the obstruction is near the gallbladder. However, this is less common and usually presents with other symptoms like vomiting and constipation.