What is the role of radiography in the evaluation of suspected gallstones (cholelithiasis)?

Updated: Apr 01, 2019
  • Author: Douglas M Heuman, MD, FACP, FACG, AGAF; Chief Editor: BS Anand, MD  more...
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Upright and supine abdominal radiographs are occasionally helpful in establishing a diagnosis of gallstone disease.

Black pigment or mixed gallstones may contain sufficient calcium to appear radiopaque on plain films. The finding of air in the bile ducts on plain films may indicate the development of a choledochoenteric fistula or ascending cholangitis with gas-forming organisms. Calcification in the gallbladder wall (the so-called porcelain gallbladder) is indicative of severe chronic cholecystitis.

The main role of plain films in evaluating patients with suspected gallstone disease is to exclude other causes of acute abdominal pain, such as intestinal obstruction, visceral perforation, renal stones, or chronic calcific pancreatitis.

See Imaging of Cholelithiasis for complete information on this topic.

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