From the Guidelines
The ultrasound findings indicate a completely normal abdominal examination with no concerning abnormalities, and therefore, no further imaging or intervention is needed based on these results. The liver shows normal size and texture without any masses or lesions. The gallbladder appears healthy with thin walls and no stones. The bile ducts are not dilated, with the common bile duct (CBD) measuring a normal 3 mm, which has a high negative predictive value for choledocholithiasis 1. The pancreas appears normal without any 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) without any stones or blockage of urine flow. There is no free fluid in the abdomen (ascites). According to the American College of Radiology, ultrasound is the recommended initial diagnostic test for patients with suspected biliary disease or right upper quadrant pain 1. The absence of any abnormalities on the ultrasound makes acute gallbladder pathology very unlikely, and the high accuracy of ultrasound in detecting gallstones and differentiating cholelithiasis from other gallbladder pathologies supports the use of ultrasound as the first-line imaging modality 1. Some key points to consider include:
- The high sensitivity and specificity of ultrasound in detecting gallstones and biliary obstruction 1
- The importance of considering clinical symptoms and concerns when interpreting ultrasound results 1
- The role of ultrasound in evaluating intrahepatic and extrahepatic bile ducts, gallbladder wall edema, pericholecystic fluid, and identifying alternative diagnoses 1
- The limitations of ultrasound in critically ill patients or in detecting certain complications of cholecystitis 1. However, in this case, the normal ultrasound findings suggest that no further imaging or intervention is necessary, and follow-up should be guided by any ongoing symptoms or clinical concerns.
From the Research
Ultrasound Findings
- The liver is normal in size and echotexture with no focal lesions, which is consistent with normal ultrasound findings 2, 3.
- The thin-walled gallbladder with no stones is also a normal finding, and ultrasound is a useful diagnostic tool for visualizing the gallbladder and identifying cholelithiasis 2.
- The absence of dilated intrahepatic ducts and a normal common bile duct (CBD) measurement of 3 mm suggests no evidence of biliary obstruction 3, 4.
Abdominal Organs
- The pancreas appears normal with no fluid in the lesser sac, which is a normal finding 3, 4.
- The spleen measures 8 cm, which is within the normal range 4.
- The abdominal aorta measures 1.3 cm, which is a normal finding, and ultrasound is a useful diagnostic tool for evaluating the abdominal aorta 2, 5.
- The right kidney measures 11.5 cm and the left kidney measures 11.7 cm, which are within the normal range 4, 5.
Diagnostic Accuracy
- The study by 3 found that gastroenterologist-operated abdominal ultrasound provides instant and accurate information relevant to the diagnosis and management of abdominal disorders.
- The study by 5 found that appropriately ordered ultrasound examinations were more likely to yield imaging findings compatible with the initial diagnosis.
- The study by 6 found that senior physicians can recognize ultrasound signs of pneumoperitoneum with a good accuracy and reliability, and that ultrasound could be a useful bedside screening test for pneumoperitoneum.
Comparison with Other Imaging Modalities
- The study by 5 compared the appropriateness of computed tomography (CT) and ultrasound for abdominal complaints in the emergency department, and found that CT scans were more likely to show no abnormalities in inappropriately ordered exams.
- The study by 6 compared the accuracy of abdominal ultrasound with abdominal radiography for the diagnosis of pneumoperitoneum, and found that ultrasound had a higher sensitivity but lower specificity than abdominal radiography.