Ultrasound Diagnosed Gallstones that were Radiolucent on a Recent CT Scan

Clinical History

A 55-year old lady presented with abdominal pain and tenderness in the right upper quadrant.

Case Description

A contrast CT scan of the abdomen and pelvis was performed which revealed an inflamed gallbladder wall with no radio-opaque gallstone seen. However, ultrasound was recommended to rule out gallstones.

Ultrasound is more sensitive in the diagnosis of cholelithiasis than CT scan. Some gallbladder calculi (cholelithiasis) can be radiolucent, therefore missed on CT. This therefore justifies abdominal ultrasound as the recommended first line of imaging, when it is available, for cases with clinically suspected cholelithiasis.

Diagnosis/ Discussion/ Treatment/ Follow up

The patient had an uneventful laparoscopic cholecystectomy.

Ultrasound is more sensitive in the diagnosis of cholelithiasis than CT scan. Some gallbladder calculi (cholelithiasis) can be radioluscent, therefore missed on CT. This is why abdominal ultrasound is the recommended first line of imaging, when it is available, for cases with clinically suspected cholelithiasis.

Sonograms