|ECR 2018 / C-2873|
|Gallbladder disorders: ultrasound as a first-line imaging examination|
Right upper quadrant (RUQ) pain is a very common symptom at emergency departments, being frequently associated with gallbladder disease. For the majority of patients, ultrasound is the preferred initial examination, with acute cholecystitis (AC) being the major diagnostic concern. 
Ultrasound has a sensibility and specificity of 88% and 80%, respectively, for acute cholecystitis, and of 84% and 99% for gallstones . Although there are a significant number of false positives results for AC, the majority of those patients have symptomatic gallstones and thus would need a cholecystectomy anyway. 
However, patients with RUQ pain most commonly have other problems. In those cases, ultrasound can exclude GD and, additionally, evaluate other potential sources of pathology related to the liver, kidney or colon. [1,3]
On the other hand, gallstones (present in up to 10% of the population)  and polyps (prevalence reports of up to 9,5%) , are common incidental findings during abdominal sonographic examinations. While gallstones are a frequent cause of pain and/or dyspeptic symptoms, polyps, particularly those with more than 10 mm in diameter should be followed up with ultrasound as adenoma and adenocarcinoma cannot be excluded.
Although the vast majority of polyps are pseudotumors (most commonly cholesterol polyps), a small percentage are true neoplasms, either malignant or with malignant potential. Considering the poor prognosis associated with gallbladder malignancy and the low morbility/mortality rates of cholecystectomy, suspicious polyps should be surgically resected.