Tests for gallbladder problems

Diagnostic Tests for Gallbladder Disease

The gallbladder — a sac located near the liver that serves as a storage space for bile — can be stricken with various problems, such as gallbladder cancer or inflammation (called cholecystitis).

Gallstones are also a common gallbladder problem, and infection can occur if the gallbladder remains blocked by a gallstone or continues to be inflamed.

Gallbladder disease is the term used to describe many of these maladies that can plague the gallbladder. But in many forms of gallbladder disease, a person may have no symptoms — up to 90 percent of people with gallstones, for example, don’t have any symptoms at all. So how can gallbladder disease be diagnosed?

Gallbladder Disease: When Diagnostic Tests Are Needed

Your doctor isn’t going to test you for something that you’re not complaining about, so generally, the only time diagnostic tests for gallbladder problems are done is when a person experiences symptoms. Warning signs of gallbladder problems include:

  • Bouts of severe pain in the right upper abdomen and sometimes the right chest or back
  • Pain after eating, particularly high-fat foods, or at night
  • Fever, with shaking and chills, especially if occurring with, or after, abdominal pain
  • Nausea and perhaps vomiting
  • Heartburn and indigestion
  • A feeling of fullness in the abdomen, or excess gas

If you don’t have symptoms, that doesn’t mean your gallbladder is perfectly normal. Often, doctors will spot signs of gallbladder problems during diagnostic testing for some other symptom or health condition.

Gallbladder Disease: Eliminating Other Causes

If you have some combination of these symptoms, your doctor probably will start by asking detailed questions about them. He may ask for more details about the pain — what it feels like, when it happens, and where in your belly it hurts. Your doctor will also ask questions to look for other possible causes of abdominal pain, like:

  • Irritable bowel syndrome (IBS)
  • Crohn’s disease or ulcerative colitis
  • Cancer or inflammation of the pancreas
  • Kidney stones or urinary tract infections
  • Pneumonia (when it involves the lower part of the right lung, it can be confused with gallbladder discomfort)
  • Viral hepatitis
  • Appendicitis
  • Gastroesophageal reflux or ulcers in the stomach
  • Diverticulitis or diverticulosis — conditions affecting the lining of the colon

Gallbladder Disease: Diagnostic Imaging Tests

After asking questions about your symptoms, doing a physical exam, and eliminating some causes from the list of possibilities, your doctor probably will perform some imaging tests to look at your gallbladder.

Imaging tests used to diagnose gallbladder problems include:

  • An ultrasound. This is the most commonly used of the diagnostic tests for gallbladder problems. While very effective in diagnosing even very small gallstones, it can’t always clearly diagnose cholecystitis (inflammation of the gallbladder).
  • X-rays. An abdominal X-ray can spot gas and some types of gallstones containing calcium. Some X-ray types require that a patient swallow a dye or have dye injected into the body so the X-ray can capture a clearer picture of the gallbladder.
  • Computed tomography (CT) scan. This imaging test uses a computer and X-rays to spot gallbladder problems, but isn’t the most effective method of diagnosing gallstones. CT scans can help spot ruptures (tears in the gallbladder wall) and infections inside the gallbladder or its bile ducts.
  • Magnetic resonance imaging (MRI) . Regular MRI, or another type called magnetic resonance cholangiography (MRC), can help diagnose stones in the bile ducts. MRC uses regular MRI imaging technology plus a dye administered into the bile duct. This test is very useful for diagnosing biliary tract (gallbladder and surrounding ducts) cancer, but may not be able to spot tiny stones or persistent infections.
  • Endoscopic retrograde cholangiopancreatography (ERCP) . This test uses an endoscope (a tube fitted with a tiny camera and light) that is inserted into the throat, down through the stomach, and into the small intestine. This test can help spot gallstones or problems in the bile ducts of the gallbladder — it’s considered the “gold standard” when it comes to diagnosing stones blocking bile ducts, and allows for removal (using a small basket-like device) during the test. But there is a risk of complications, so the test is typically only given to people who are thought to be very likely to have stones blocking the bile ducts.
  • Cholescintigraphy (also called DISIDA, HIDA scan, or gallbladder radionuclide scan). A small amount of radioactive dye is administered, and then a scanning device is used to track the dye as it moves into the gallbladder. This screening method can spot a blocked duct and acute inflammation, but not chronic gallbladder inflammation or gallstones.

Gallbladder Disease: Blood and Urine Tests

A blood test may also be performed to help diagnose gallbladder disease. A complete blood count, or CBC, can help confirm an infection if there is a high white blood cell count. Other specific blood tests can also reveal high bilirubin levels (the cause of jaundice, a complication of gallbladder problems) or elevated enzymes suggesting an obstruction in the gallbladder.

Urine tests may also be performed to help diagnose problems with the gallbladder by looking for abnormal levels of chemicals like amylase, which is an enzyme that aids in the digestion of carbohydrates, and lipase, another enzyme that helps break down fats.

Even if signs and symptoms are not directly suggesting gallbladder disease, your doctor has many ways to visualize the gallbladder. With these tests, your gallbladder disease can usually be promptly diagnosed — and just as importantly, properly treated.

Tests to Diagnose Gallstone Disease

The digestive system, including the gallbladder

What tests are done to detect gallstones?

Gallstone disease can develop in many different ways. A number of tests may be used to establish the diagnosis:

  • Ultrasound: Ultrasound testing uses sound waves to take images of the gallbladder. It is the gold-standard to look for gallstones because it is simple and non-invasive. Ultrasound is very good at highlighting gallstones within the gallbladder, as well as features, such as a thickened gallbladder wall, that point to inflammation of the gallbladder (acute cholecystitis).
  • Liver function tests (LFTs): Although these tests are not done specifically for gallstone disease, a simple blood test looking at the enzyme levels in the liver can show inflammation in the gallbladder caused by gallstones. Other combinations of liver tests are arranged if gallstones fall out of the gallbladder and are blocking the bile duct, which can lead to jaundice (the skin, whites of the eyes and mucous membranes turn yellow).
  • Complete blood count (CBC): If there is inflammation caused by gallstones, the white blood cell count is usually elevated (higher). In this situation, the patient will often have a fever.
  • Computed tomography (CT): This test uses X-rays to construct detailed images of the abdominal organs. CT can give additional information on the bile ducts and liver, which may be affected by gallstone disease.
  • HIDA scan (cholescintigraphy): During this test, a radioactive material called hydroxy iminodiacetic acid (HIDA) is injected into the patient. The material is taken up by the gallbladder and shows how the gallbladder is functioning. This test is useful when the ultrasound result is inconclusive, especially if there is acute inflammation of the gallbladder and the outlet of the gallbladder is blocked. It is also beneficial when the gallbladder is diseased but there are no stones present (acalcalous cholecystitis).
  • Magnetic resonance cholangiopancreatography (MRCP): This test uses magnetic resonance imaging (MRI) to produce detailed pictures of the biliary tree (liver, gallbladder and bile ducts). It is of particular use to look at the bile ducts for signs of stones that have escaped from the gallbladder and are blocking the bile duct, which can lead to jaundice.
  • Endoscopic retrograde cholangiopancreatography (ERCP): In this procedure, a tube is placed down the patient’s throat, into the stomach, then into the small intestine. Dye is injected and the ducts of the gallbladder, liver, and pancreas can be seen on X-ray. ERCP is now mainly used to treat patients in whom a gallstone has blocked the bile duct causing pancreatitis (inflammation of the pancreas), jaundice or cholangitis (infection of the bile).

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Gallbladder Disease Diagnosis

Diagnosis of Gallbladder Disease

Abdominal x-rays are not used to diagnose gallbladder disease. Only about 20 percent of gallstones are dense enough to be seen on x-ray—most blend in with the soft tissue structures of the abdomen.

Before the advent of ultrasound, the imaging test most used to visualize the gallbladder was the oral cholecystogram. In this test, an oral contrast agent (dye) was given to the patient the night before the test and would be flushed from the body through the gallbladder and bile ducts. When the agent appeared in the gallbladder, the radiologist used fluoroscopic equipment to look for stones.

Lighter gallstones would be present within the gallbladder fluid. If the dye concentrated in the gallbladder, it indicated that the organ was functioning to some extent. Conversely, if the dye didn’t appear in the gallbladder, the gallbladder was not functioning properly and perhaps should be removed.

The oral test was able to detect problems in the gallbladder, but was not able to detect problems in other parts of the bile system, such as the main bile duct. To detect other problems, intravenous cholangiogram (IVC) was used.

This test involved the injection of a contrast agent, which caused side effects, such as nausea and rare life-threatening reactions. IVC involved special x-rays called tomograms that provided good images of the main bile ducts, enabling the radiologist to detect gallstones. In some cases, however, the images were inadequate due to technical problems, poor uptake of the dye by the liver, and other issues.

Ultrasound

In most cases, ultrasound is the first imaging test for gallbladder and bile duct abnormalities. This test is non-invasive, uses no dyes, and is not painful. Ultrasound produces good images of the small ducts in the liver and the higher part of the major bile duct. However, the lower part of the duct, where it enters the GI tract, is where gallstones often get stuck. This lower part is close to the gastrointestinal (GI) tract and air produced in the GI tract deflects the sound waves. If ultrasound cannot detect the condition, other tests that can add valuable information.

Radionuclide Biliary Scan

This nuclear medicine test is not only an imaging test, but a function test as well. The patient is given an injection of a radioactive tracer and then imaging is done under a camera for up to several hours, but usually for no more than 30 to 45 minutes. From this test, the radiologist can determine if the isotope is picked up and excreted by the liver and can often tell if the cystic duct is blocked because, if it is, the gallbladder does not receive any radioactive material.

The radiologist can also see whether or not the common bile duct is blocked. Ordinarily, the tracer should pass right through this duct and end up in the GI tract within a short period of time. If it gets stuck and is not seen in the GI tract, it can be assumed that the main duct is blocked.

CT Scan

In most cases, CT scan is not used to detect gallstones, but this imaging test does have its uses in the biliary system. First of all, the entire main duct can be seen using CT scan because unlike ultrasound, air in the GI tract does not interfere with CT. High-speed CT with computer-assisted reformatting capabilities allows the radiologist to move quickly through numerous images. The ability of CT to find stones in the common bile duct approximates ultrasound. In general, CT scan is a better test for more complicated problems, although it may be used together with ultrasound.

Transhepatic Cholangiogram (THC)

This interventional procedure involves placing a small needle into the liver and injecting dye into the bile ducts. THC is a very good test for evaluating the bile duct, but this test has definite risks. The improvements in ultrasound and CT imaging, as well as the emergence of MRI, were important factors in reducing the number of routine transhepatic cholangiograms.

Endoscopic Retrograde Cholangiopancreaticogram (ERCP)

Endoscopic retrograde cholangiopancreaticogram (ERCP) is often performed by gastroenterologists or surgeons, and not by radiologists. This test involves putting a tube into the patient’s mouth, down the throat, into the stomach, through the duodenum and then, into the common bile duct. ERCP is performed with the patient sedated.

Looking through the tube, the gastroenterologist is able to locate the hole in the duodenum where the bile comes in from the common bile duct. A smaller tube or catheter is passed through this hole and contrast material is injected. The contrast agent (dye) also can be injected into the pancreatic duct, showing that ductal system as well.

The thick endoscopic tube affords visualization and other things as well. If the problem is a stone in the lower bile duct, the gastroenterologist can often put a basket into the tube and snare the stone and remove it. If the problem is tumor, the endoscopist can insert a biopsy device and remove a small piece of tissue for review by the pathologist.

Finally, the endoscopist can help open the connection between the common bile duct and the duodenum by cutting the muscle that encircles the valve (sphincterotomy)—allowing stones that would have been trapped at the junction to flow right on through.

Magnetic Resonance Imaging (MRI scan)

Magnetic resonance imaging has spawned the new field of MRI cholangiography. With or without contrast material, MRI is able to show the bile in the bile ducts from many different angles. Some believe that MRI is about as good a modality for detecting stones in the bile ducts as there is, excluding the much more interventional transhepatic cholangiogram. Problems with MRI include limited availability in certain areas, limited cholangiographic skills and experience, and relatively high costs.

Imaging Summary

If gallbladder stones are suspected, and ultrasound is usually performed. If more complicated issues concerning the gallbladder or bile ducts are suspected, a CT scan, an MRI scan, or both may be performed. A radionuclide biliary scan also may provide useful information. Interventional tests, such as ERCP or THC are performed for complicated and serious conditions.

Publication Review By: Stanley J. Swierzewski, III, M.D.

Published: 01 May 2000

Last Modified: 22 Jul 2015

Gallstones

How are gallstones treated?

Treatment of gallstones may not be necessary if you do not have symptoms. However, if you have cholecystitis, or if you are having symptoms related to gallstones, the standard treatment is intravenous antibiotics and surgical removal of the gallbladder (cholecystectomy). In most cases, your surgeon will perform a cholecystectomy laparoscopically (with endoscopes placed through small incisions in your abdomen).

If the gallstones have also caused blockage of the biliary ducts, other procedures may be performed, including:

  • Endoscopic retrograde cholangiopancreatography (ERCP): ERCP is used to examine the bile ducts using an endoscope, a flexible tube that is passed from the mouth through the stomach and into the duodenum. Iodinated contrast material is injected into the bile ducts to locate gallstones that may be causing blockage. Some stones may be successfully removed during ERCP.
  • Percutaneous transhepatic cholangiography (PTC): PTC is performed by making a small incision on the skin, and advancing a needle into the bile ducts. Iodinated contrast material is injected into the bile ducts to locate gallstones that may be causing blockage. Some stones can be removed during a PTC and others may be bypassed by leaving a catheter or small thin tube in place.

If your doctor decides that you are too sick to undergo surgery, there are other procedures that may be done until surgery can be performed.

  • Cholecystostomy tube placement: A cholecystostomy tube is a small plastic tube (catheter) placed into your gallbladder through a small incision in the skin. The aim of this procedure is to decompress the distended, blocked and inflamed gallbladder by emptying out the backed up, under pressure bile in your gallbladder and diverting it outside the body into a bag attached to the tube. This allows decrease in pain and inflammation in the gallbladder and allows time for the antibiotics to work and for the surgery to be performed at a later date. However, it does not treat the underlying cause (the stones).

Gallbladder problems are diagnosed through various tests. These may include:

  • Liver tests, which are blood tests that can show evidence of gallbladder disease.
  • A check of the blood’s amylase or lipase levels to look for inflammation of the pancreas. Amylase and lipase are enzymes (digestive chemicals) produced in the pancreas.
  • A complete blood count (CBC), which looks at levels of different types of blood cells such as white blood cells. A high white blood cell count may indicate infection.
  • The use of ultrasound testing which uses sound waves to image and make a picture of the intra-abdominal organs including the gallbladder.
  • A computed tomography (CT) scan constructs a detailed X-ray images of the abdominal organs.
  • A HIDA scan. In this test, a radioactive material called hydroxy iminodiacetic acid (HIDA) is injected into the patient. The radioactive material is taken up by the gallbladder to measure gallbladder emptying function. This test also is referred to as cholescintigraphy.
  • Magnetic resonance cholangiopancreatography (MRCP), which uses magnetic resonance imaging (MRI) to produce detailed pictures.
  • Endoscopic retrograde cholangiopancreatography (ERCP), a procedure in which a tube is placed down the patient’s throat, into the stomach, then into the small intestine. Dye is injected and the ducts of the gallbladder, liver, and pancreas can be seen on X-ray.

Gallstones

  • ultrasound (introduction)
  • ultrasound physics
    • basic physics
      • absorption
      • acoustic impedance
      • attenuation
      • decibel
      • propagation speed
      • reflection
      • refraction
      • scattering
    • transducers
      • ultrasound frequencies
      • piezoelectric effect
      • linear array
      • convex array
      • phased array
      • beam focusing
      • beam steering
      • gain
      • time gain compensation
      • power output
      • focal zone
      • dynamic range
      • frame rate
      • line density
      • frame averaging (frame persistence)
      • ultrasound image resolution
        • axial resolution
        • lateral resolution
        • elevational (azimuthal) resolution
        • temporal resolution
    • imaging modes and display
      • pulse-echo imaging
        • grey-scale imaging
        • time-gain compensation
        • harmonic imaging
      • real-time imaging
      • Doppler imaging
        • Doppler effect
        • color Doppler
        • power Doppler
        • B flow
        • color box
        • Doppler angle
        • pulse repetition frequency and scale
        • wall filter
        • color write priority
        • packet size (dwell time)
        • resistive index
        • pulsatility index
      • panoramic imaging
      • compound imaging
      • harmonic imaging
      • elastography
        • transient elastography
        • shear wave elastography
        • strain elastography
        • Young’s modulus
      • scanning modes
        • 2D ultrasound
        • 3D ultrasound
        • 4D ultrasound
        • M-mode
    • ultrasound artifacts
      • acoustic shadowing
      • acoustic enhancement
      • beam width artifact
      • reverberation artifact
        • comet tail artifact
          • color comet tail artifact
        • ring down artifact
      • mirror image artifact
      • side lobe artifact
      • speed displacement artifact
      • refraction artifact
      • multipath artifact
      • anisotropy
      • electrical interference artifact
      • Doppler artifacts
        • aliasing
        • tissue vibration
        • spectral broadening
        • blooming
        • motion (flash) artifact
        • twinkle artifact
        • acoustic streaming
    • biological effects of ultrasound
      • mechanical index
      • thermal index
    • history of ultrasound
  • obstetric ultrasound
    • other
      • polyhydramnios
      • oligohydramnios
      • anhydramnios
      • gestational trophoblastic disease
      • retained products of conception
    • placenta
      • low lying placenta
      • placental abruption
      • placenta previa
      • vasa previa
      • abruption
      • placenta percreta
      • placenta increta
      • placenta accreta
      • circumvallate placenta
      • succenturiate placenta
      • velamentous cord insertion
      • marginal cord insertion
      • uteroplacental blood flow assessment
      • placental tumors
    • second trimester​
      • fetal biometry
        • basic biometry
          • biparietal diameter (BPD)
          • head circumference (HC)
          • abdominal circumference (AC)
          • femur length (FL)
      • fetal morphology assessment
        • fetal echocardiography views
      • soft markers
        • nuchal fold thickness
        • ventriculomegaly
        • absent nasal bone
          • hypoplastic nasal bone
        • echogenic intracardiac focus
        • choroid plexus cysts
        • echogenic bowel
        • aberrant right subclavian artery
      • amnioreduction
      • echogenic fetal bowel
      • umbilical artery Doppler assessment
        • absent umbilical arterial end diastolic flow
        • reversal of umbilical arterial end diastolic flow
    • chorionic villus sampling (CVS) and amniocentesis
    • nuchal translucency
    • failed early pregnancy
    • subchorionic hematoma
    • multiple gestations
      • monochorionic monoamniotic twin pregnancy
      • monochorionic diamniotic twin pregnancy
      • dichorionic diamniotic twin pregnancy
        • twin peak sign
    • ectopic pregnancy
      • tubal ectopic
      • interstitial or cornual ectopic
      • cervical ectopic
      • ovarian ectopic
      • abdominal ectopic
      • heterotopic pregnancy
      • Cesarean scar ectopic
    • first trimester and early pregnancy
      • gestational sac
        • double decidual sac sign
        • intradecidual sac sign
        • mean sac diameter
        • empty gestational sac
        • pseudogestational sac
      • yolk sac
      • embryo/fetus
        • crown-rump length (CRL)
        • fetal heart rate
          • fetal tachycardia
          • fetal bradycardia
          • fetal bradyarrhythmia(s)
        • physiologic gut herniation
        • embryonic rhombencephalon
      • amnion
      • chorion
      • Beta-hCG levels
  • gynecologic ultrasound
    • acute pelvic pain
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        • endometrial thickness
          • abnormal endometrial thickness differential
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      • myometrium
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        • Mullerian agenesis or hypoplasia
        • unicornuate uterus
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        • DES-related uterine abnormalities
    • ovaries
      • ovarian torsion
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        • tubo-ovarian abscess complex
      • ovarian cysts and masses
        • ovarian cyst
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        • dermoid
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      • paraovarian cyst
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      • pelvic congestion syndrome
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  • vascular ultrasound
    • carotids
      • internal carotid artery
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    • extremities
      • ankle brachial index
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      • chronic mesenteric ischemia
    • ​other
      • fibrin sheath
      • tardusparvus
  • breast ultrasound
    • benign and malignant characteristics of breast lesions at ultrasound
    • hyperechoic breast lesions on ultrasound
    • differential diagnosis of dilated ducts on breast imaging
  • musculoskeletal ultrasound
    • technique/artifacts
      • anisotropy
    • ultrasound of arthropathies
      • musculoskeletal manifestations of rheumatoid arthritis
    • skin/soft tissue ultrasound
      • lipoma
      • parasitic infection
        • scrotal filariasis
        • filarial dance sign
    • other
      • sonographic features of malignant lymph nodes
      • sonography of peripheral nerves
    • pediatric musculoskeletal ultrasound
      • ultrasound classification of developmental dysplasia of the hip
        • alpha angle
        • beta angle
    • ankle/foot ultrasound
      • Morton neuroma
    • knee ultrasound
      • Baker cyst (popliteal cyst)
      • infrapatellar bursitis
    • hip ultrasound
      • Morel-Lavallee lesion
    • hand ultrasound
      • gamekeeper thumb
      • glomus tumor
    • wrist ultrasound
      • anterior interosseous nerve syndrome
      • carpal tunnel syndrome
      • ganglion cyst
    • elbow ultrasound
      • medial epicondylitis
      • ulnar nerve dislocation
      • snapping triceps syndrome
      • lateral epicondylitis
    • shoulder ultrasound
      • sonographic evaluation of rotator cuff tears
  • liver ultrasound
    • liver
      • focal
        • hyperechoic liver lesions
        • hypoechoic halo sign / target lesions
        • simple hepatic cyst
        • hepatic hemangioma
        • focal nodular hyperplasia
        • hepatic adenoma
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        • hepatic abscess
      • diffuse
        • acute hepatitis
        • cirrhosis
        • hyperechoic liver
          • diffuse hepatic steatosis
        • coarsened hepatic echotexture
        • generalized decrease in hepatic echogenicity
        • “starry sky appearance” of the liver
      • hepatic vasculature
        • normal hepatic vein Doppler
        • portal hypertension
        • portal vein thrombosis
        • developed collaterals / portosystemic shunts
      • other
        • hepatic trauma on ultrasound
    • liver transplant
      • hepatic arterial resistive index
    • biliary
      • choledocholithiasis
      • dilated intrahepatic bile ducts
      • bile duct wall thickening
      • cholangiocarcinoma
      • Mirizzi syndrome
  • gallbladder ultrasound
    • diffuse gallbladder wall thickening (differential)
    • focal gallbladder wall thickening (differential)
    • gallstones
      • twinkling artifact
      • wall-echo-shadow sign
    • gallbladder sludge
      • hepatisation of the gallbladder
    • acute cholecystitis
      • acalculous cholecystitis
      • gangrenous cholecystitis
      • perforated gallbladder
      • emphysematous cholecystitis
      • hemorrhagic cholecystitis
    • chronic cholecystitis
    • gallbladder polyp
      • benign vs malignant gallbladder polyps
      • cholesterol polyps
      • adenoma
      • inflammatory polyps
    • gallbladder cholecystoses
      • adenomyomatosis
      • gallbladder wall cholesterolosis
        • strawberry gallbladder
    • porcelain gallbladder
    • gallbladder carcinoma
    • gallbladder metastases
    • gallbladder lymphoma
    • gallbladder volvulus / torsion
    • variants
      • phrygian cap
      • agenesis
      • duplication
    • variants and anomalies
      • phrygian cap
      • agenesis
      • duplication
  • pancreatic ultrasound
    • pancreatitis
      • acute
      • chronic
      • pseudocyst
    • pancreatic necrosis
    • pancreatic abscess
    • pancreatic carcinoma
    • pancreatic endocrine tumors / islet cell tumors
    • cystic pancreatic neoplasms
    • intraductal papillary mucinous neoplasm (IPMN)
    • pancreatic metastases
    • pancreatic lymphoma
    • pancreatic trauma
    • pancreas transplant
  • gastrointestinal ultrasound
    • appendicitis
    • hyperechoic bowel
    • inguinal hernia
  • renal ultrasound
    • hydronephrosis
    • renal stone
    • focal lesion
      • renal cyst
      • autosomal dominant polycystic kidney disease
      • renal cell carcinoma
      • urothelial cell carcinoma / transitional cell carcinoma
      • angiomyolipoma
    • diffuse
      • pyelonephritis
      • renal abscess
    • renal vascular
      • renal artery stenosis
    • renal transplant ultrasound
      • renal artery stenosis
      • renal vein thrombosis
      • pseudoaneurysm
      • arteriovenous fistula
    • other
      • renal trauma
  • bladder ultrasound
    • bladder wall thickening
      • urothelial carcinoma of the bladder
      • bladder outlet obstruction
      • neurogenic bladder
      • infectious cystitis
      • cystitis following radiation or chemotherapy
    • bladder diverticulum
    • bladder calculi
    • ureterocele
    • pseudoureterocele
    • schistosomiasis
  • testicular and scrotal ultrasound
    • other
      • polyorchidism
      • cryptorchidism
      • tubular ectasia of the rete testis
      • cystadenoma of the rete testis
      • testicular sarcoidosis
      • testicular tuberculosis
      • spermatic cord lipoma
      • scrotal leiomyosarcoma
      • fibrous pseudotumor of the scrotum
      • testicular adrenal rest tumors (TARTs)
      • splenogonadal fusion
      • inguinal hernia
    • epididymis
      • epididymo-orchitis
      • epididymal abscess
      • epididymal head cyst
      • torsion of the epididymal appendix
      • adenomatoid tumor
    • paratesticular lesions
      • hydrocele
      • spermatocele
      • haematocele
      • scrotoliths
      • cyst of the tunica albuginea
      • varicocele
    • bilateral testicular lesion
      • testicular microlithiasis
      • testicular lymphoma
      • metastases to the testicle
    • unilateral testicular lesion
      • testicular torsion
      • orchitis
      • testicular rupture
      • germ cell tumor of the testis
        • testicular seminoma
        • non seminomatous germ cell tumors
          • mixed germ cell tumor
          • yolk sac tumor (endodermal sinus tumor)
          • embryonal cell carcinoma
          • choriocarcinoma
          • testicular teratoma
          • testicular epidermoid (teratoma with ectodermal elements only)
        • burned out testis tumor
      • sex cord / stromal tumors of the testis
        • Leydig cell tumor
  • prostate ultrasound
    • transrectal ultrasound (TRUS)
    • prostate carcinoma
    • prostatitis
  • other lower genitourinary ultrasound
    • urachal cyst
    • urethra
    • penis
      • Peyronie’s disease
      • priapism
  • neck and thyroid ultrasound
    • thyroid
      • multinodular goiter
      • colloid cyst
      • thyroglossal duct cyst
    • parathyroid
  • echocardiography
    • echocardiographic modalities
      • transthoracic echocardiography (TTE)
      • transesophageal echocardiography (TEE)
      • three dimensional (3D) echocardiography
      • epicardial echocardiography
      • contrast enhanced echocardiography
      • fetal echocardiography
      • speckle tracking echocardiography
    • physics and imaging modes
      • grey-scale (B-mode)
      • motion mode (M-mode)
      • color flow Doppler (CFD)
      • spectral Doppler
        • pulsed wave Doppler (PWD)
        • continuous wave Doppler (CWD)
      • tissue Doppler imaging (TDI)
    • left ventricular systolic and diastolic function
      • structure and morphology
      • systolic function
        • ejection fraction (EF)
        • global longitudinal strain (GLS)
        • wall motion score index (WMSI)
        • cardiac output
        • depressed LV systolic function
      • diastolic function
        • mitral inflow pulsed wave Doppler
        • pulmonary venous Doppler
        • mitral annular tissue Doppler imaging
        • diastolic dysfunction
    • right ventricular assessment
      • structure and morphology
      • right ventricular (RV) dysfunction
    • right and left atria
      • right atrial enlargement
      • left atrial enlargement
    • valvular structure and function
      • mitral valve
        • mitral regurgitation
        • mitral stenosis
      • aortic valve
        • aortic stenosis
        • aortic regurgitation
      • pulmonic valve
        • pulmonic regurgitation
        • pulmonic stenosis
      • tricuspid valve
        • tricuspid regurgitation
        • tricuspid stenosis
    • hemodynamics
      • cardiac tamponade
      • ventricular interdependence
      • dynamic left ventricular outflow tract obstruction
      • differentiation of shock states
        • focus assessed transthoracic echocardiography
    • pericardium
      • pericardial effusion
      • constrictive pericarditis
    • cardiomyopathies
      • restrictive cardiomyopathy
      • hypertrophic cardiomyopathy
      • left ventricular non-compaction
      • arrhythmogenic right ventricular cardiomyopathy
      • dilated cardiomyopathy
    • congenital heart disease
      • echocardiographic approach
      • deductive echocardiography
    • great vessels
      • thoracic aorta
        • thoracic aortic aneurysm
        • thoracic aortic dissection
      • main pulmonary artery
        • pulmonary embolism
      • inferior vena cava
        • collapsability index
        • distensibility index
      • superior vena cava
  • pediatric ultrasound
    • intussusception
    • appendicitis
    • vesicoureteric reflux grading
    • transcranial ultrasound
  • ultrasound interventions
    • ultrasound-guided biopsy
      • fine needle aspiration (FNA)
        • cell block cytology
        • gene expression classifier
      • core biopsy
      • ultrasound-guided renal biopsy
      • ultrasound-guided breast biopsy
      • ultrasound-guided liver biopsy
      • ultrasound-guided biopsy of a peripheral soft tissue mass
    • ultrasound-guided percutaneous drainage
      • thoracentesis
    • ultrasound-guided musculoskeletal interventions
      • joint injection
      • nerve blocks
        • interscalene brachial plexus block
    • ultrasound-guided intravenous cannulation
  • contrast-enhanced ultrasound
    • liver
      • hepatic metastasis
      • cystadenoma/cystadenocarcinoma
      • cholangiocarcinoma
      • hepatocellular carcinoma
      • hepatic adenoma
      • focal nodular hyperplasia
      • hepatic hemangioma
    • kidney
      • renal cell carcinoma
      • complex renal cysts
      • angiomyolipoma
      • ischemia/infarction

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