Acute Cholecystitis

We have two images of the week this week.  The first single image comes from Emily Hirsh.  She has a great example of a normal gallbladder in its longitudinal axis.  She has appropriately labeled the anterior gallbladder wall, to ensure it is less than 3mm. 

The following images come from Douglas Ander.  He diagnosed a patient with an incredibly sick gallbladder: a very large anterior wall (>9mm!), pericholecystic fluid, and a sonographic Murphy's sign.  

Following these findings, he was able to identify the common bile duct (CBD). 

It lies just anterior to the portal vein.  Notice the use of color flow to identify flow in the portal vein, but no flow in the CBD.  Identifying the CBD is more difficult, and represents one of the ACEP emergency ultrasound guidelines' "emerging applications."