Top 5 Tips for Biliary Ultrasound

ICEM Conference Pearls of Wisdom

POCUS Workshop Instructor Lynne Johnson

1. Roll the patient at approximately 45 degrees onto their left side.

2. In order to localise the gallbladder, identify the right kidney in the transverse plane and move the probe medially. The gallbladder should be identified in the transverse plane slight more anteriorly. Hopefully you will see it subcostally, however intercostal scanning may be required for high-riding livers.

3. Fan the probe through the gallbladder in the transverse plane from the neck to the fundus and back. Decrease the depth and measure the wall thickness at the anterior midline portion, never laterally, as the lateral resolution is poor compared to the axial resolution.

4. After turning the probe clockwise 90 degrees to identify the gallbladder in the longitudinal plane, make sure you heel/toe the probe to interrogate as much of the gallbladder as possible, particularly the neck for any stones that may be impacted. Sit the patient up to discern the mobility of any stones/sludge.

5. When hunting for the bile duct, angle the probe in the right costal margin at the level of the porta hepatis. The probe marker should be pointing to their right shoulder. Elongate on the main portal vein and the proper hepatic artery should be seen in cross-section with the bile duct coursing anteriorly. Color Doppler may be used to differentiate the vessels.


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