Annals of Emergency Medicine
Volume 56, Issue 2 , Pages 114-122 , August 2010

A Prospective Evaluation of Emergency Department Bedside Ultrasonography for the Detection of Acute Cholecystitis

Presented at the Western Regional Research Forum, Plenary Session, January 2009, Park City, UT; at the American Institute of Ultrasound in Medicine, April 2009, New York, NY; and as a poster at the Society of Academic Emergency Medicine, May 2009, New Orleans, LA.

Received 24 June 2009 ,Revised 20 December 2009 ,Accepted 12 January 2010.

  • Image Result

    Long-axis view of the gallbladder demonstrates a large gallstone impacted in the neck (white arrow), without evidence of wall thickening or pericholecystic fluid. The patient had a sonographic Murphy'

    Long-axis view of the gallbladder demonstrates a large gallstone impacted in the neck (white arrow), without evidence of wall thickening or pericholecystic fluid. The patient had a sonographic Murphy's sign.

  • Image Result
    Long-axis view of a distended gallbladder reveals multiple gallstones with shadowing and significant gallbladder wall thickening. Note the appearance of the gallbladder wall with multiple alternating

    Long-axis view of a distended gallbladder reveals multiple gallstones with shadowing and significant gallbladder wall thickening. Note the appearance of the gallbladder wall with multiple alternating hyperechoic and hypoechoic layers (white arrows).

  • Image Result
    In the same patient as discussed in Figure 2, a transverse view near the fundus of the gallbladder is remarkable for a wedge of pericholecystic fluid (white arrow).

    In the same patient as discussed in Figure 2, a transverse view near the fundus of the gallbladder is remarkable for a wedge of pericholecystic fluid (white arrow).

  • Image Result
    Number of patients scanned per physician, by experience level and registered diagnostic medical sonographer status.

    Number of patients scanned per physician, by experience level and registered diagnostic medical sonographer status.

  • Image Result
    Long-axis view of the right upper quadrant in a postprandial patient demonstrates the classic appearance of a contracted gallbladder with narrow lumen and slightly thickened wall (white arrow). The ga

    Long-axis view of the right upper quadrant in a postprandial patient demonstrates the classic appearance of a contracted gallbladder with narrow lumen and slightly thickened wall (white arrow). The gallbladder was readily identified by its proximity to the portal triad (black arrow). The patient had no gallstones and a negative sonographic Murphy's sign.

 Supervising editor: William R. Mower, MD, PhD

 Author contributions: SMS drafted the article. SMS, MDM, and JCF contributed to article revision. WS, SSC, and JCF conceived the study. WS and SSC designed the study. WS and OA prepared the IRB. S Lanham collected data, surveyed the electronic medical record for pathology reports, and performed telephone follow-ups. S Lanham and OA assisted with literature review. CA managed the data and performed the statistical analysis. S Lotfipour assisted with patient recruitment and supervised data collection. S Lotfipour and JCF supervised the conduct of the trial and provided quality control. SMS takes responsibility for the paper as a whole.

 Funding and support: By Annals policy, all authors are required to disclose any and all commercial, financial, and other relationships in any way related to the subject of this article that might create any potential conflict of interest. See the Manuscript Submission Agreement in this issue for examples of specific conflicts covered by this statement. JCF has been a consultant for Sonosite Corp (Bothell, WA) for ultrasound education. Sonostie was not involved in the study in any capacity. He received no royalties, sponsorship, or funding for this study.

 Publication date: Available online February 5, 2010.

 Reprints not available from the authors.

 Please see page 115 for the Editor’s Capsule Summary of this article.

PII: S0196-0644(10)00037-5

doi: 10.1016/j.annemergmed.2010.01.014

Annals of Emergency Medicine
Volume 56, Issue 2 , Pages 114-122 , August 2010

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