Point-of-care ultrasound (POCUS) of the gallbladder is an essential skill for clinicians evaluating patients with right upper quadrant pain, suspected cholecystitis, or biliary pathology. Locating the gallbladder can be challenging, especially in non-fasting patients where bowel gas may obscure the view. In this hot tip, we’ll cover a practical step-by-step technique to reliably find the gallbladder using an intercostal flank approach a method that improves visualization and minimizes interference.
Starting Position and Probe Setup
For this scan, we begin with the patient in a flank position, placing the curvilinear probe in an oblique orientation. The probe indicator should point toward approximately the 10–11 o’clock position.
Using the abdomen preset, the initial image will often show the spinal projections in the far field with corresponding shadowing. Just anterior to this, you should visualize the right kidney. This is a reliable landmark that helps avoid bowel gas interference when imaging patients who are not fasting.
Why Use the Flank Approach?
In patients who have recently eaten, keeping the probe more anteriorly risks running into bowel gas, which obscures visualization. By localizing the kidney from the flank, you can fan anteriorly from a stable intercostal position to reach the gallbladder without shifting into gas-filled areas.
Step-by-Step Technique
- Localize the Kidney - With the probe in the intercostal flank position, identify the right kidney.
- Fan Anteriorly - Without sliding the probe, gently fan anteriorly. As you do this, you’ll see the porta hepatis come into view.
- Visualize the Gallbladder - Continuing to fan will bring the gallbladder into view. In this example, the patient was not fasting, which produced a slightly thickened gallbladder wall due to contraction during digestion a normal finding.
- Optimize the View
Once the gallbladder is visualized, you can:
- Twist the transducer to elongate the gallbladder for a long-axis view.
- Take a transverse approach for additional assessment.
- Perform a sonographic Murphy’s sign by tracing the gallbladder up into the right upper quadrant and applying pressure to evaluate for tenderness.
Key Takeaway
By starting with the right kidney in the intercostal flank position and fanning anteriorly, you can efficiently identify the gallbladder even in non-fasting patients. This approach helps bypass bowel gas and provides a reliable method for POCUS gallbladder evaluation.
Watch the full video demonstration above to see this technique in action!
Ready to refine your skills and gain confidence in ultrasound-guided injections and procedures like this? Call the Gulfcoast Ultrasound Institute at 727-363-4500 for all of your ultrasound training needs! We’re conveniently located at 111 2nd Ave NE, #800, St. Petersburg, FL 33701.
Whether you’re looking to sharpen your technique or learn new applications, we’re here to help.
