Stone in neck, but mobile

Images by Genevieve Carbonatto  

A patient presents with acute onset epigastric pain associated with vomiting.  The decision is made to examine his GB for the possibility the cause being biliary colic. The following is his ultrasound.

There is a 2.19 cm stone in the neck of the GB. Could this be the cause of his pain? To evaluate whether the stone is stuck in the neck, the patient is rolled over into the left lateral decubitus position. This is now his scan

The stone has now moved into the body of the GB and away from the neck. The cause of this man’s symptoms is very unlikely to be his gallstone since the stone is not impacted in the neck of the GB. The wall of the GB is not thickened.

Whenever stones are visualised it is important to see whether they move. This is possible by moving the patient from the supine to the lateral decubitus or the erect position. The examples below have little clinical relevance in the context of RUQ pain as the stones are not in the neck of the GB in the supine position but they demonstrate how moving the patient causes stones to move.

More examples:

Stone near the neck in the supine position, stone in fundus when patient is erect.

Stones in the body in the supine position. Stones move to the fundus when the patient is erect

 

 

 

 

 

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