Preliminary Diagnosis: Cholelithiasis

I. What imaging technique is first-line for this diagnosis?

Transabdominal right upper quadrant ultrasound. Ideally, patient is NPO for 8 hours to distend the gallbaldder and optimize imaging of the gallbladder wall and contents.

II. Describe the advantages and disadvantages of this technique for diagnosis of cholelithiasis.

  • Very high sensitivity and specificity for detecting gallstones
  • Ultrasound is safe, fast, and cheap.
  • May also identify possible complications from cholelithiasis (e.g., cholecystitis, choledocholithiasis)
  • Effectiveness decreases with obese body habitus

III. What are the contraindications for the first-line imaging technique?

No contraindications to transabdominal ultrasound

IV. What alternative imaging techniques are available?

CT cholangiography (IV contrast infusion)

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V. Describe the advantages and disadvantages of the alternative techniques for diagnosis of cholelithiasis.

CT cholangiography (IV contrast infusion)
  • CT is indicated only when transabdominal ultrasound is not possible, typically due to obese body habitus. It can reliably detect cholelithiasis, but if complications from cholelithiasis are suspected, then the appropriate imaging techniques should be used. (See cholecystitis, choledocholithiasis, and cholangitis.)

VI. What are the contraindications for the alternative imaging techniques?

CT cholangiography (IV contrast infusion)
  • Due to radiation exposure, CT should be used conservatively in the pediatric population and is contraindicated in pregnancy. Requires administration of IV contrast infusion, which is contraindicated in patients with renal insufficiency.