Abdominal Ultrasound Interpretation Report

Diagnostic Radiology — Right Upper Quadrant Focus

Report ID: MAA-USA-8E3D14
Generated: May 18, 2026
Analysis: AI-Powered Image Interpretation

Patient Profile

Sex / Age:
Female, 45 years
Height / Weight:
166 cm / 88 kg (BMI 31.9)
Reported symptoms:
Recurrent right upper quadrant pain after fatty meals, lasting 1–3 hours; episode tonight ongoing 4 h, with one episode of vomiting; mild fever (37.6 °C)
Examination:
RUQ tenderness, positive Murphy's sign reported clinically; no jaundice
History:
Two pregnancies, oral contraceptive use, family history of cholelithiasis (mother)

Summary Overview

Right upper quadrant ultrasound demonstrates cholelithiasis with sonographic features of acute cholecystitis: gallbladder wall thickening, pericholecystic fluid, and a sonographic Murphy's sign. No biliary ductal dilation. Liver, pancreas (visualized portions), and kidneys appear unremarkable.

+
Cholelithiasis
5.4 mm
GB Wall
5 mm
CBD

Detailed Imaging Findings

GallbladderAbnormal
Wall thickness
5.4 mm
Largest stone
14 mm
Pericholecystic fluid
Present
Distended gallbladder with multiple shadowing intraluminal echogenic foci consistent with cholelithiasis (largest 14 mm). Wall is diffusely thickened (5.4 mm; normal < 3 mm), with hyperemia on color Doppler and a small rim of pericholecystic fluid. Sonographic Murphy's sign positive — focal tenderness over the gallbladder during transducer pressure. The combination of stones + wall thickening + pericholecystic fluid + Murphy's sign carries a high positive predictive value for acute cholecystitis [Pinto A, World J Radiol 2013].
Common Bile Duct (CBD)Normal
Diameter
5 mm
Normal
≤ 6–7 mm
Choledocholithiasis
Not seen
CBD diameter within normal limits. No visible intraductal stone. This argues against concomitant choledocholithiasis, though small stones can be missed by ultrasound; clinical/biochemical correlation (LFTs, lipase) is necessary.
LiverNormal
Normal size, contour, and echotexture. No focal lesion. Mild increased echogenicity could suggest mild steatosis; non-specific and clinically correlative.
Pancreas (visualized portions)Normal
Visualized head and body unremarkable; tail partially obscured by bowel gas. No peripancreatic fluid.
KidneysNormal
Both kidneys normal in size, echotexture, and corticomedullary differentiation. No hydronephrosis or stone.
Spleen / Aorta / Free FluidNormal
Spleen normal in size. Aorta normal caliber. No free intraperitoneal fluid outside the immediate pericholecystic region.

Differential Diagnosis

  • Acute calculous cholecystitisHigh
    Stones + wall thickening + pericholecystic fluid + sonographic Murphy's = classic combination [Pinto A 2013; Tokyo Guidelines TG18, J Hepatobiliary Pancreat Sci 2018].
  • Symptomatic cholelithiasis (biliary colic) without inflammationLow
    Less likely given inflammatory features. Distinguishing requires correlation with WBC, fever, and clinical course.
  • Choledocholithiasis / cholangitisLow
    CBD not dilated and no jaundice; correlation with LFTs and lipase recommended. MRCP/EUS if biochemical suspicion arises.
  • Gallbladder polyp / massLow
    No fixed mural lesion identified. The visualized echogenic foci shadow and move with positioning, consistent with stones rather than polyps.

Analytical Summary & Recommendations

Imaging impression

Findings are highly suggestive of acute calculous cholecystitis. Imaging by itself does not establish severity grade; clinical and laboratory data are needed.

Recommended next steps (clinical correlation)

  • Correlate with WBC, CRP, LFTs (AST, ALT, ALP, total bilirubin), and lipase
  • Apply Tokyo Guidelines (TG18) criteria for diagnosis and severity grading [Yokoe M, J Hepatobiliary Pancreat Sci 2018]
  • Surgical consultation for laparoscopic cholecystectomy within 72 hours of symptom onset (preferred for early cholecystitis) [Gurusamy KS, Cochrane 2013]
  • If poor surgical candidate: IV antibiotics, supportive care, and percutaneous cholecystostomy as bridge therapy
  • If LFTs become abnormal or duct dilation develops: MRCP / EUS to evaluate for CBD stones
⚠ Important
Acute cholecystitis is a surgical / hospital-level diagnosis. Worsening pain, persistent fever > 38.5 °C, vomiting, jaundice, or any signs of sepsis (high HR, low BP, confusion) warrant emergency department care. Untreated cholecystitis can progress to gangrene, perforation, or cholangitis.

Key Questions for Your Physician

  • Do I need surgery now, or can this be managed first with antibiotics and surgery later?
  • What blood tests do you want to check before deciding?
  • Are there signs of complications (perforation, gangrene, bile duct involvement)?
  • What dietary and lifestyle changes should I make if surgery is delayed?
  • What red-flag symptoms should send me back to the emergency department immediately?

What This Means for You

Your ultrasound shows gallstones and signs that your gallbladder is inflamed — a condition called acute cholecystitis. The pain you have been having after fatty meals, combined with the current longer-lasting episode, fits well with this diagnosis.

The standard treatment is removal of the gallbladder (cholecystectomy), usually performed laparoscopically within a few days of presentation. This is one of the most common operations and recovery is typically fast. In some situations (very high surgical risk, poor general condition), the team may choose to control the inflammation first with antibiotics or a temporary drain, and operate later.

Your bile duct looks normal and there is no jaundice, which is reassuring — there is no current evidence that a stone has moved into the duct. Your liver and kidneys also look normal.

Go to emergency care immediately if your pain becomes severe and unrelenting, you develop high fever, your skin or eyes turn yellow, or you feel dizzy/lightheaded.

Analysis Confidence 91%

High confidence in cholecystitis given multi-parameter sonographic concordance and characteristic clinical features. Final severity grading and surgical timing are clinical decisions.

References

  1. Yokoe M, Hata J, Takada T, et al. Tokyo Guidelines 2018: diagnostic criteria and severity grading of acute cholecystitis. J Hepatobiliary Pancreat Sci 2018;25(1):41–54.
  2. Pinto A, Reginelli A, Cagini L, et al. Accuracy of ultrasonography in the diagnosis of acute calculous cholecystitis: review of the literature. Crit Ultrasound J 2013;5(Suppl 1):S11.
  3. Gurusamy KS, Davidson C, Gluud C, Davidson BR. Early versus delayed laparoscopic cholecystectomy for people with acute cholecystitis. Cochrane Database Syst Rev 2013;(6):CD005440.
  4. ACR Appropriateness Criteria — Right Upper Quadrant Pain. American College of Radiology 2018.
  5. Strasberg SM. Clinical practice. Acute calculous cholecystitis. NEJM 2008;358(26):2804–11.