A middle-aged M presents with R sided / epigastric abdominal pain. Symptoms for a few days, getting worse. No fevers, nausea, vomiting, or diarrhea. He’s tender to palpation in the RUQ. Vital signs are normal.
POCUS Biliary within minutes of ED arrival shows acute cholecystitis. We see the hyperechoic (white) rim of a gallstone stuck in the neck of the gallbladder casting an acoustic shadow. The anterior gallbladder wall is thick, with a small amount of pericholecystic fluid. He has a positive sonographic Murphy’s sign.
SONO Pearls: I advocate for placing the patient in the left lateral decubitus position with their right arm extended over their head. The curvilinear transducer is placed in the epigastrium in the sagittal position.