Emergency Biliary Sonography: Utility of Common Bile Duct Measurement in the Diagnosis of Cholecystitis and Choledocholithiasis



      Measurement of the common bile duct (CBD) has traditionally been considered an integral part of gallbladder sonography, but accurate identification of the CBD can be difficult for novice sonographers.


      To determine the prevalence of isolated sonographic CBD dilation in emergency department (ED) patients with cholecystitis or choledocholithiasis without laboratory abnormalities or other pathologic findings on biliary ultrasound.


      We conducted a retrospective chart review on two separate ED patient cohorts between June 2000 and June 2010. The first cohort comprised all ED patients undergoing a biliary ultrasound and subsequent cholecystectomy for presumed cholecystitis. The second cohort consisted of all ED patients receiving a biliary ultrasound who were ultimately diagnosed with choledocholithiasis. Ultrasound data and contemporaneous laboratory values were collected. Postoperative gallbladder pathology reports and endoscopic retrograde cholangiopancreatography (ERCP) reports were used as the criterion standard for final diagnosis.


      Of 666 cases of cholecystitis, there were 251 (37.7%) with a dilated CBD > 6 mm and only 2 cases (0.3%; 95% confidence interval [CI] 0.0–0.7%) of isolated CBD dilation with an otherwise negative ultrasound and normal laboratory values. Of 111 cases of choledocholithiasis, there were 80 (72.0%) with a dilated CBD and only 1 case (0.9%; 95% CI 0.0–2.7%) with an otherwise negative ultrasound and normal laboratory values.


      The prevalence of isolated sonographic CBD dilation in cholecystitis and choledocholithiasis is <1%. Omission of CBD measurement is unlikely to result in missed cholecystitis or choledocholithiasis in the setting of a routine ED evaluation with an otherwise normal ultrasound and normal laboratory values.


      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Journal of Emergency Medicine
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Blaivas M.
        • Harwood R.A.
        • Lambert M.S.
        Decreasing length of stay with emergency ultrasound examination of gallbladder.
        Acad Emerg Med. 1999; 10: 1020-1023
        • Spence S.C.
        • Teichgraeber D.
        • Chandrasekhar C.
        Emergent right upper quadrant sonography.
        J Ultrasound Med. 2009; 28: 479-496
        • American College of Emergency Physicians
        Emergency ultrasound guidelines.
        Ann Emerg Med. 2009; 53: 550-570
        • Kiewiet J.J.
        • Leeuwenburgh M.M.
        • Bipat S.
        • Bossuyt P.M.
        • Stoker J.
        • Boermeester M.A.
        A systematic review and meta-analysis of diagnostic performance of imaging in acute cholecystitis.
        Radiology. 2012; 264: 708-720
        • Pereira-Limâ J.C.
        • Jakobs R.
        • Busnello J.V.
        • Benz C.
        • Blaya C.
        • Riemann J.F.
        The role of serum liver enzymes in the diagnosis of choledocholithiasis.
        Hepatogastroenterology. 2000; 47: 1522-1525
        • Yang M.H.
        • Chen T.H.
        • Wang S.E.
        • et al.
        Biochemical predictors for absence of common bile duct stones in patients undergoing laparoscopic cholecystectomy.
        Surg Endosc. 2008; 22: 1620-1624
        • Weinstein B.J.
        • Weinstein D.P.
        Biliary tract dilatation in the nonjaundiced patient.
        AJR Am J Roentgenol. 1980; 134: 899-906
        • Contini S.
        • Dalla Valle R.
        • Campanella G.
        Reliability of ultrasounds in detecting common bile duct stones before biliary surgery. A retrospective analysis.
        Panminerva Med. 1997; 39: 106-110
        • Hunt D.R.
        Common bile duct stones in non-dilated bile ducts? An ultrasound study.
        Australas Radiol. 1996; 40: 221-222
        • Bose S.M.
        • Mazumdar A.
        • Prakash V.S.
        • Kocher R.
        • Katariya S.
        • Pathak C.M.
        Evaluation of the predictors of choledocholithiasis: comparative analysis of clinical, biochemical, radiological, radionuclear, and intraoperative parameters.
        Surg Today. 2001; 31: 117-122
        • Lichtenbaum R.A.
        • McMullen H.F.
        • Newman R.M.
        Preoperative abdominal ultrasound may be misleading in risk stratification for presence of common bile duct abnormalities.
        Surg Endosc. 2000; 14: 254-257
        • Majeed A.W.
        • Ross B.
        • Johnson A.G.
        • Reed M.W.
        Common duct diameter as an independent predictor of choledocholithiasis: is it useful?.
        Clin Radiol. 1999; 54: 170-172
        • Summers S.M.
        • Scruggs W.
        • Menchine M.D.
        • et al.
        A prospective evaluation of emergency department bedside ultrasonography for the detection of acute cholecystitis.
        Ann Emerg Med. 2010; 56: 114-122
        • Banks P.A.
        • Bollen T.L.
        • Dervenis C.
        • et al.
        Classification of acute pancreatitis—2012: revision of the Atlanta classification and definitions by international consensus.
        Gut. 2013; 62: 102-111
        • Wada K.
        • Takada T.
        • Kawarada Y.
        • et al.
        Diagnostic criteria and severity assessment of acute cholangitis: Tokyo Guidelines.
        J Hepatobiliary Pancreat Surg. 2007; 14: 52-58