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. 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 B-mode image showing the gallbladder containing some calculi B-mode image of the gallbladder calculus impacted in the gallbladder neck Longitudinal view of the normal common bile duct B-mode image of the gallbladder showing an increased wall thickness of 5.5 mm in AP calibre Axial CT of the gallbladder performed just prior to ultrasound showing some wall inflammation, however, no radiopaque calculus was seen Published on: September 25, 2024
