Gallstone disease diagnostic study of choice

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Hadeel Maksoud M.D.[2]

Gallstone disease Microchapters


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Differentiating Gallstone disease from other Diseases

Epidemiology and Demographics

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Natural History, Complications and Prognosis


Diagnostic Study of Choice

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Case #1

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The best modality for detecting gallstones is a transabdominal ultrasound (TAUS). Patients who present with right upper quadrant pain are suspected of having gallstone disease. The patients symptoms are usually accompanied by a normal physical examination and normal laboratory results including those for leukocytosis and pancreatic enzyme levels. In obese patients, or patients where imaging is practically difficult an esophageal ultrasound (EUS) with high sensitivity may be used.

Diagnostic Study of Choice

Gold standard/Study of choice:

  • Investigations:
    • Among patients who present with clinical signs of gallstone disease, the transabdominal ultrasound is the most specific test for the diagnosis.
    • Gallstones appear as echogenic foci that cast an acoustic shadow and exhibit gravitational dependence.
    • Gravel has a similar appearance to stones and are also echogenic and cast shadows.
    • Sludge is echogenic but does not cast shadows.

The comparison table for diagnostic study of choice for gallstone disease[6]

Test characteristic Sensitivity Specificity
TAUS 84% 99%
Diagnostic results

The following result of transabdominal ultrasound is confirmatory of gallstone disease:[1][2][3]

Sequence of Diagnostic Studies

The transabdominal ultrasound should be performed when:

Diagnostic Criteria

  • There is no particular established diagnostic criteria for gallstone disease.
  • Diagnosis is based upon history, symptoms and possibly, gallstone detection with transabdominal ultrasound.
Case courtesy of by Dr Derek Smith, from the case <ahref="">rID: 42795</a>


  1. 1.0 1.1 Leopold GR, Amberg J, Gosink BB, Mittelstaedt C (1976). "Gray scale ultrasonic cholecystography: a comparison with conventional radiographic techniques". Radiology. 121 (2): 445–8. doi:10.1148/121.2.445. PMID 981625.
  2. 2.0 2.1 Conrad MR, Janes JO, Dietchy J (1979). "Significance of low level echoes within the gallbladder". AJR Am J Roentgenol. 132 (6): 967–72. doi:10.2214/ajr.132.6.967. PMID 108978.
  3. 3.0 3.1 Brink JA, Simeone JF, Mueller PR, Richter JM, Prien EL, Ferrucci JT (1988). "Physical characteristics of gallstones removed at cholecystectomy: implications for extracorporeal shock-wave lithotripsy". AJR Am J Roentgenol. 151 (5): 927–31. doi:10.2214/ajr.151.5.927. PMID 3263025.
  4. Filly RA, Allen B, Minton MJ, Bernhoft R, Way LW (1980). "In vitro investigation of the origin of echoes with biliary sludge". J Clin Ultrasound. 8 (3): 193–200. PMID 6769957.
  5. Lee SP, Maher K, Nicholls JF (1988). "Origin and fate of biliary sludge". Gastroenterology. 94 (1): 170–6. PMID 3275565.
  6. Shea JA, Berlin JA, Escarce JJ, Clarke JR, Kinosian BP, Cabana MD, Tsai WW, Horangic N, Malet PF, Schwartz JS (1994). "Revised estimates of diagnostic test sensitivity and specificity in suspected biliary tract disease". Arch. Intern. Med. 154 (22): 2573–81. PMID 7979854.

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