Acute inflammation of the gallbladder presents with severe RUQ pain localized to the gallbladder area. The pain can be elicited by (gently!) pressing the gallbladder with the ultrasound transducer a positive ultrasound Murphy’s sign. (This sign, although a useful pointer to acute inflammation, is
not specific and can frequently be elicited in other conditions, such as chronic inflammatory cases.) On ultrasound, the gallbladder wall is thickened greater than 2 mm. This is not in itself a specific , but characteristically the thickening in acute cholecystitis is symmetrical, affecting the entire wall, and there is an echo-poor ‘halo’ around the gallbladder as a result of oedematous changes , This is not invariable, however, and focal thickening may be present, or the wall may be uniformly hyperechoic in some cases. Pericholecystic fluid may also be present, and the inflammatory process may spread to the adjacent liver. Colour or power Doppler can be helpful in diagnosing acute cholecystitis and in differentiating it from other causes of gallbladder wall thickening. Hyperaemia in acute cholecystitis can be demonstrated on colour Doppler around the thickened wall13 . In a normal gallbladder, colour Doppler flow may be seen around the gallbladder neck in the region of the cystic artery but not elsewhere in the wall. The increased sensitivity of power Doppler, as opposed to colour.