Medical necessity: Evaluate for gallstones and dilated common bile duct and sonographic signs or cholecystitis, such as “positive sonographic Murphy’s sign,” thickened gall bladder wall, and pericholecystic fluid

Structures studied: Gallbladder (GB), common bile duct

 Guidelines

1.) Obtain a video clip of the GB in it’s entirety, in both the longitudinal and transverse planes.

2.) Obtain a static image of the GB in the transverse plane with a measurement of the anterior GB wall.

Transverse View of Gallbladder

Anterior wall Measurement in the transverse plane

3.) Obtain a static image of the Common bile duct (CBD).

Common bile duct measurement

 

Critical Measurements

COMMON BILE DUCT

  • <5mm-normal in patients up to age 50 (Add 1 mm for every decade of life thereafter)
  •  5-7mm equivocal
  •  >7mm-dilated

Gallbladder wall

  •  <3mm-normal
  •  3-4mm-equivocal
  •  >4mm-dilated
 

Note: The left lateral decubitis, in addition to the supine position, is generally superior for the GB and CBD visualization.


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