Spotting Acute Cholecystitis on POCUS: What to Look For, What Fools You, and Why it Matters
Case Presentation
A 45-year-old woman with no past medical history presents to the emergency department with right upper quadrant pain that started about 10 hours ago, shortly after dinner. She's had intermittent episodes like this before, usually after eating fatty or greasy foods, but they always dissipated within a few hours. This time, the pain hasn't subsided and has been constant since it started. She also endorses nausea and had one episode of non-bilious, non-bloody emesis. She looks very uncomfortable sitting on the stretcher.
Vitals: HR 98, BP 134/82, temp 38.2°C, O₂ sat 99% on room air. On exam, she's got significant right upper quadrant tenderness with guarding and a positive Murphy's sign. Labs come back with a WBC count of 13,200 and normal liver enzymes.
What would you expect to see on ultrasound? And what's the diagnosis?
