Why is ultrasonography the imaging study of choice in the workup of suspected gallstone disease (cholelithiasis)?

Updated: Apr 01, 2019
  • Author: Douglas M Heuman, MD, FACP, FACG, AGAF; Chief Editor: BS Anand, MD  more...
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Ultrasonography is the procedure of choice in suspected gallbladder or biliary disease; it is the most sensitive, specific, noninvasive, and inexpensive test for the detection of gallstones. [14] Moreover, it is simple, rapid, and safe in pregnancy, and it does not expose the patient to harmful radiation or intravenous contrast. An added advantage is that it can be performed by skilled practitioners at the bedside. The American College of Radiology (ACR) in its Appropriateness Criteria right upper quadrant pain, published in 2010, supports this conclusion. [15]

Sensitivity is variable and dependent upon operator proficiency, but in general, it is highly sensitive and specific for gallstones greater than 2 mm. It is less so for microlithiasis or biliary sludge.

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