What are the key components of an ultrasound (USG) report for a patient with suspected cholelithiasis?

Key Components of an Ultrasound Report for Suspected Cholelithiasis

Ultrasound is the first-line imaging modality for suspected cholelithiasis with 96% accuracy for detecting gallstones, and should be the initial diagnostic test for patients with right upper quadrant pain or suspected biliary disease. 1

Essential Components of a Cholelithiasis Ultrasound Report

Gallbladder Assessment

• Presence or absence of gallstones, including number, size, mobility, and acoustic shadowing 1
• Differentiation between gallstones, sludge, polyps, or masses 1
• Gallbladder wall thickness (normal <3mm; thickened wall may suggest cholecystitis) 1
• Gallbladder size and shape (contracted or distended) 1
• Presence of sonographic Murphy sign (focal tenderness over the sonographically localized gallbladder) 1
• Presence of pericholecystic fluid 1

Biliary Tree Evaluation

• Common bile duct diameter (normal <6mm, or <8-10mm in elderly or post-cholecystectomy patients) 1
• Presence or absence of intrahepatic biliary dilation 1
• Direct visualization of common bile duct stones, if present 1
• Assessment of the pancreaticobiliary junction 1

Liver Assessment

• Liver parenchyma appearance 1
• Evidence of cirrhosis or other hepatic pathology 1

Pancreas Assessment

• Visualization of pancreatic head (when possible) 1
• Signs of pancreatitis (if present) 1

Special Considerations

For Suspected Acute Cholecystitis

• Document specific findings suggestive of acute inflammation: 1
  • Gallbladder wall thickening >3mm
  • Pericholecystic fluid
  • Sonographic Murphy sign
  • Gallbladder distension

For Suspected Complicated Cholecystitis

• Document findings suggestive of complications: 1
  • Intraluminal hyperechoic blood products (hemorrhagic cholecystitis)
  • Intraluminal gas or gas in gallbladder wall (emphysematous cholecystitis)
  • Intraluminal debris or membranes
  • Discontinuity of gallbladder wall (perforation)

For Suspected Common Bile Duct Stones

• Note that direct visualization of common bile duct stones on ultrasound is a strong predictor of choledocholithiasis 1
• Document that ultrasound has limitations in detecting small common bile duct stones (sensitivity ranges from 22.5% to 75%) 1, 2
• Consider recommending additional imaging (MRCP, EUS, or ERCP) if clinical suspicion for choledocholithiasis remains high despite negative ultrasound 2, 3

Technical Considerations

• Document technical adequacy of the examination 1
• Note any limitations (e.g., bowel gas, body habitus) 1
• Include measurements of structures when appropriate 1

Follow-up Recommendations

• For patients with confirmed gallstones receiving medical therapy (e.g., ursodeoxycholic acid), recommend follow-up ultrasound at 6-month intervals for the first year 4
• For asymptomatic gallstones, consider recommending observation unless patient falls into a high-risk group 5
• For suspected common bile duct stones with negative ultrasound but high clinical suspicion, consider recommending additional imaging such as MRCP, EUS, or ERCP 2, 6, 7

Common Pitfalls to Avoid

• Relying solely on sonographic Murphy sign, which has relatively low specificity for acute cholecystitis 1
• Overlooking small common bile duct stones, which may be missed on ultrasound 2, 3
• Misinterpreting increased common bile duct diameter as definitive evidence of choledocholithiasis, especially in elderly patients where biliary duct tone may be decreased 1
• Failing to document technical limitations that may affect diagnostic accuracy 1