Every gallbladder and right upper quadrant frame this library holds, in order: the normal sac first, then a stone with the calipers on it, then a thickened wall, then free fluid in the space between the liver and the right kidney. Eight of the nine carry the depth, frequency and gain on their own screen.
Acerca de la Dra. Mariz
I am Dr. Fernando Mariz, a gynecology and pelvic surgery physician practicing in New York City. Before my medical career, I served in the U.S. Marine Corps, where I developed the discipline, focus, and steadiness that continue to shape the way I care for patients today. At Maiden Lane Medical, my work covers women’s health, preventive care, sonography, pelvic pain, abnormal uterine bleeding, and minimally invasive gynecologic procedures.
Acerca del Dr. Ávila
I am Dr. Jailyn Avila, an emergency medicine physician, educator, and digital health innovator based in Southern California. My clinical work is rooted in emergency care, while my teaching focuses on point-of-care ultrasound, residency education, and practical training for physicians. Through my roles with Emergent Medical Associates, UHS SoCal MEC Emergency Medicine Residency, Core Ultrasound, and FemInEM, I work at the intersection of patient care, medical education, and accessible digital learning.
Respuesta rápida
A gallbladder ultrasound settles four things: whether there are stones in the lumen, whether the wall is thicker than 3 mm, whether the bile duct at the porta hepatis is dilated beyond about 6 mm, and whether there is free fluid in the space between the liver and the right kidney. A normal gallbladder is an anechoic pear shaped sac with a single thin bright wall, imaged with a curvilinear probe at 4 to 6 MHz after at least 4 hours of fasting. A gallstone is an echogenic focus that casts a clean posterior shadow and rolls to the dependent side when the patient turns onto the left side. A thickened wall is the least specific finding on the exam: heart failure, hepatitis, renal failure, sepsis, low serum albumin, ascites and a recent meal all produce one. Free fluid collects in the hepatorenal recess because that is a dependent space in a supine patient, and it fills the gap between the two organs instead of pushing either of them aside. My own working rule on the wall is to distrust the measurement until a stone and tenderness under the probe are sitting next to it.
Here for the hardware rather than the exam? Abdominal probe choices are collected on the gastroenterology hub, and the D3Ultra product page lists what the head is specified to do and what it costs today.
Image atlas
Nine frames, normal first
These are the gallbladder and right upper quadrant recordings in the Scan Library, all of them, in teaching order. Eight of the nine carry the acquisition settings burned into their own panel, read off the screen rather than typed in afterwards; figure 4 is the exception, and its caption says so. Seven of the nine are shown exactly as the library holds them, at their own true size. The other two are figure 2, cropped to the scan panel of a tablet recording, and figure 4, which reached the library already cropped on both edges — both captions state it. Where the library recorded the model, the model is named. Where it did not, the frame says so and the device is described as what it is.
Two things are worth knowing before the first image. Four of these recordings come from one study on 2018-03-15 and were made inside ninety seconds of one another, so they are four windows on one abdomen rather than four patients; the captions say which. And every frame here is grey scale B mode, which is the mode these four questions are actually answered in at the bedside. If you give two of the nine real attention, I would make them figure 1 and figure 3: the normal sac and the normal liver and kidney interface. Every other frame on this page is a departure from one of those two.
Read off the screen
- Dispositivo Suresult D3Ultra
- Recorded2026-07-14 08:56 (on-screen clock)
- PanelConvex array · F 3.2 MHz · D 160 mm · GN 81 dB · DR 80 · ENH 2 · Compound OFF · MI 0.6 · TIS 0.1 · frozen at 100/100
- FileJPEG 2235 × 1158
Read off the screen
- Dispositivo Suresult D3Ultra
- Recorded2026-01-22 21:34 (on-screen clock)
- PanelConvex array · F H5.0 MHz · D 160 mm · GN 97 dB · DR 80 · ENH 2 · Compound OFF · MI 0.7 · TIS 0.1 · live, 100/100
- FileMP4 1600 × 846 · 10.6 s · 241 frames
Read off the screen
- Dispositivo Suresult wireless convex probe (clinical reference library; model not recorded)
- Recorded2017-01-07 12:03 (on-screen clock)
- PanelF H5.0 MHz · D 200 mm · gain 83 dB · DR 60 dB · ENH 4 · 100 frame cine replay
- FileMP4 864 × 656 · 10 s · 100 frames
Read off the screen
- Dispositivo Suresult wireless convex probe (clinical reference library; model not recorded)
- Recordedreference library, Chinese language interface
- PanelSettings panel cropped out of this export; frequency, depth and gain are not legible. A caliper pair is placed; the measurement label reads LENGTH and the value itself is clipped at the right edge of the export.
- FileJPEG 577 × 498
Read off the screen
- Dispositivo Suresult wireless convex probe (clinical reference library; model not recorded)
- Recorded2018-03-15 08:50:00 to 08:50:12 (on-screen clock)
- PanelF H5.0 MHz · D 200 mm · GN 80 dB · DR 80 · ENH 2 · 100 frame cine replay
- FileMP4 912 × 672 · 10 s · 100 frames
Read off the screen
- Dispositivo Suresult wireless convex probe (clinical reference library; model not recorded)
- Recorded2018-03-15 08:51:19 (on-screen clock)
- PanelF H5.0 MHz · D 200 mm · GN 80 dB · DR 80 · ENH 2 · frozen at 100/100
- FileJPEG 1781 × 1293
Read off the screen
- Dispositivo Suresult wireless convex probe (clinical reference library; model not recorded)
- Recorded2018-03-15 08:49:55 (on-screen clock)
- PanelF H5.0 MHz · D 200 mm · GN 80 dB · DR 80 · ENH 2 · frozen at 100/100
- FileJPEG 891 × 647
Read off the screen
- Dispositivo Suresult wireless convex probe (clinical reference library; model not recorded)
- Recorded2018-03-15 08:50:25 to 08:50:37 (on-screen clock)
- PanelF H5.0 MHz · D 200 mm · GN 80 dB · DR 80 · ENH 2 · 100 frame cine replay
- FileMP4 480 × 352 · 10 s · 100 frames
Read off the screen
- Dispositivo Suresult wireless convex probe (clinical reference library; model not recorded)
- Recorded2017-01-07 12:04:47 (on-screen clock)
- PanelF H5.0 MHz · D 200 mm · gain 83 dB · DR 60 dB · ENH 4 · frozen at 100/100
- FileJPEG 875 × 669
Frames 3 to 9 come from the 2017 to 2020 clinical reference library, recorded on two devices with two different panel layouts. The 2017 device writes its parameters in Chinese, 增益 for gain and 深度 for depth: that is figures 3 and 9. The 2018 device writes the same two values in English as GN: and D:, and keeps 冻结 for freeze and 回放 for cine replay: that is figures 5 to 8. Figure 4 is from the same library, carries no parameter panel, and has its date sliced away in the export, so it is the one frame here that cannot be dated. Every value that is legible is transcribed into the settings cards above in the usual notation. The on-screen ID, name, gender and age fields on every frame on this page are the demonstration values the device ships with, and they are shown as recorded. One further capture from the current-hardware library was reviewed and left out: the structure on its screen is not anechoic, so it could not be published as a normal gallbladder.
Reading the images
What this exam shows
Four structures, and the order you find them in matters. The liver comes first because it is the acoustic window for everything else; put the probe under the right costal margin and the liver is the large, even, mid-grey organ filling the near field. The gallbladder hangs off its under-surface as the one thing on the screen that is completely black, because bile is fluid and fluid returns no echo. Follow the interlobar fissure back from the gallbladder neck and it lands on the portal vein at the porta hepatis, where the bile duct and the hepatic artery run alongside it. Slide the probe down and laterally and the liver meets the right kidney at a single bright line: the hepatorenal recess.
Those four give you the whole exam. A stone is an echogenic focus in the black lumen with a clean shadow behind it, and it shadows whatever it is made of. A thickened wall is a wall over 3 mm, measured on the anterior wall in short axis with the beam square to it, because an oblique cut through a curved wall reads thicker than the wall is. A dilated duct is a tube at the porta hepatis wider than about 6 mm, and B mode alone cannot tell you which of the three tubes there is the duct. Free fluid is a dark stripe that fills the gap at the hepatorenal recess rather than displacing either organ.
What I want you to take from this set is the negative. The most useful frame here is the one where liver and kidney lie against each other with a single bright line between them, because you cannot recognise the abnormal version until you have watched the normal one a dozen times.
Acquisition
How the scan is done
A curvilinear probe, at 4 to 6 MHz for an adult, is the default; a phased array is the fallback where the gallbladder only appears through an intercostal window. Fasting comes first: the joint ACR, AIUM, SPR and SRU practice parameter asks for at least 4 hours before an elective study, because a gallbladder that has emptied after a meal contracts and a contracted wall measures falsely thick.
Start supine with the probe subcostal in the right upper quadrant, long axis to the gallbladder, and have the patient take a deep breath and hold it, which drops the liver and the gallbladder below the costal margin and into view. Rock through the organ in long axis, then rotate 90 degrees and sweep it in short axis; the same parameter asks for long-axis and transverse views of the gallbladder, and it is ACEP Sonoguide that puts the anterior wall measurement in the short axis view. Then roll the patient into the left lateral decubitus position and scan again. That last step is not optional decoration: it is how a stone is separated from a polyp, because the stone moves to the new dependent wall and the polyp does not.
At the porta hepatis, turn colour on. The practice parameter allows Doppler to be used to separate hepatic arteries and portal veins from bile ducts, and in practice the vein and the artery fill with colour while the duct stays empty. Finish in the hepatorenal recess with the probe in the right mid-axillary line around the eleventh rib space, fanning from the diaphragm to the caudal edge of the liver.
Fast comparison
Normal versus abnormal, structure by structure
Read the fourth column with the other three. Most of the diagnostic mistakes in this exam are not failures to see something; they are findings read without the thing that qualifies them.
| What you are looking at | Normal | Abnormal | What the frame still cannot settle |
|---|---|---|---|
| The lumen | Anechoic, uniformly black, no internal echoes. | Echogenic focus that shadows, or layered dependent material that shifts with position. | A single frozen frame cannot show whether the focus moves, and movement is what separates a stone from a polyp. |
| The wall | One thin bright line, 3 mm or less on the anterior wall in short axis. | Thicker than 3 mm, sometimes layered or oedematous. | Thickening is non-specific. Heart failure, hepatitis, renal failure, sepsis, low albumin, ascites and a recent meal all do it. |
| The duct at the porta hepatis | Usually 6 mm or less on transabdominal scanning, measured inner wall to inner wall. | Dilated beyond that, or dilated intrahepatic branches. | B mode alone cannot say which tube is the duct. Colour Doppler is what settles it. |
| The space between liver and right kidney | The two organs sit against one another and the interface is a single bright line. | A dark stripe that fills the gap and takes the shape of the recess. | Free fluid here does not name a cause, and a negative view does not exclude a small volume. |
| Tenderness | No focal pain when the probe presses over the gallbladder. | Maximal pain exactly under the probe with the gallbladder on screen. | This is a bedside finding, not an image finding. No still on this page records it. |
Wall limit and measurement technique: ACEP Sonoguide y Gupta et al., World Journal of Gastroenterology 2020. Duct limit and the post-surgical exception: Rizvi et al., Cleveland Clinic Journal of Medicine 2022. The widely taught rule of adding 1 mm per decade after 60 is a convention rather than a settled finding — Horrow et al. in Radiology could not confirm an association between age and duct size at all, and the Cleveland Clinic review that repeats the rule says in the same sentence that the evidence varies. How much free fluid this window needs before a reader sees it has been measured: Branney et al. in the Journal of Trauma put the mean detected volume at 619 mL, with one reader in ten seeing less than 400 mL. All sources accessed September 14, 2026.
Hardware
Device and settings
The left column is the published specification; the right column is what the device interface actually showed while these frames were acquired, and the right column is the one to copy. Note the depths. Every reference-library capture whose panel is legible ran at 200 mm, and the two D3Ultra captures ran at 160 mm, which is a deep abdominal setting on a convex array. That one number is what I would buy on. A high-frequency linear array is not a good fit for this window at any price, and no amount of gain repairs it. If the abdomen is the whole job, the convex-only probe below reaches those depths for less outlay. Paying for a head that carries three geometries only starts to make sense once the same device is expected to cover lung, vascular and musculoskeletal work as well.
Published specification
Suresult D3Ultra
Three geometries, one head — $2,976
- Convexo3.2 / 5.0 MHz · 90–300 mm · 45°
- Por fases3.2 / 5.0 MHz · 90–300 mm · 60°
- Lineal7.5 / 10 MHz · 20–100 mm · 40 mm
- Signal path192 elements · 64 channels · 256 grey levels
- Gain range30–105 dB · dynamic range 40–110
- Efecto DopplerColour, Power and PW, alongside B and M
- Handpiece156 × 65 × 20 mm · 263 g · 2 h scanning
- Connects toiOS, Android, Windows · dual-band Wi-Fi
Read off the screen across these nine frames
- PresetNot shown on any frame published here
- ArrayConvex on every frame
- ProfundidadD 160 mm on the two D3Ultra frames, D 200 mm on every legible library frame
- FrecuenciaF 3.2 MHz and F H5.0 MHz
- GaneGN 80 to 97 dB across the set
- Dynamic rangeDR 60 to 80 · ENH 2 and 4
- OutputMI 0.6 to 0.7 · TIS 0.1, on the two D3Ultra frames
- ModosB mode throughout · the one caliper pair is on the stone in figure 4
Same window, other exams
Related scans
The eFAST exam, narratedThe same hepatorenal window inside the trauma protocol, with the other three views and a full transcript.Open
Kidney ultrasound imagesThe organ on the far side of the same interface, normal and abnormal, with the renal patterns worth recognising.Open
The whole Scan LibraryEvery clinical recording Suresult holds, sortable by anatomy and by probe.OpenThe chest side of the same diaphragm, on the same convex depth setting, is the pleural effusion image atlas.
Everything else the library holds sits in the Biblioteca de escáneres, sortable by anatomy and by probe.
Asked on this search
Gallbladder ultrasound questions
What can a gallbladder ultrasound see?
It sees the gallbladder lumen, the gallbladder wall, the bile duct at the porta hepatis and the space between the liver and the right kidney. That is enough to answer four questions: are there stones, is the wall thickened, is the duct dilated, and is there free fluid around the liver. It does not see the cystic duct directly, and it does not measure gallbladder function.
Do you have to fast before a gallbladder ultrasound?
Yes. The joint ACR, AIUM, SPR and SRU practice parameter asks for fasting of at least 4 hours before an elective abdominal scan so that a normally functioning gallbladder fills and distends. A gallbladder that has just emptied after a meal contracts, and a contracted wall reads falsely thick.
What does a normal gallbladder look like on ultrasound?
An anechoic pear shaped sac with a thin bright wall, sitting against the liver in the right upper quadrant. The accepted upper limit for the wall is 3 mm, measured on the anterior wall in short axis with the beam perpendicular to it. In normal subjects the wall averaged 2.6 plus or minus 1.6 mm, so 3 mm is a conservative working line rather than a biological boundary.
How accurate is ultrasound for gallstones?
The standard meta-analysis reports sensitivity of 0.97 and specificity of 0.95 for cholelithiasis, which become 0.84 and 0.99 once verification bias is corrected. Bedside scans by emergency physicians reached over 86 percent sensitivity and 88 percent specificity. For acute cholecystitis rather than stones alone, pooled figures are lower at 81 percent and 83 percent.
Does a thickened gallbladder wall mean cholecystitis?
No. Wall thickening is one of the least specific findings in abdominal ultrasound. Hepatitis, congestive heart failure, renal failure, sepsis and low serum albumin all thicken the wall with no gallbladder disease at all, and so do ascites and a recent meal. The finding becomes meaningful only alongside stones and tenderness under the probe.
Provenance
Sources and image provenance
- ACR, AIUM, SPR and SRU. Practice Parameter for the Performance of an Ultrasound Examination of the Abdomen and/or Retroperitoneum (revised 2026)The required gallbladder views, the fasting interval, where the duct is measured, the instruction to test for a sonographic Murphy sign, and the use of Doppler to separate ducts from vessels. Accessed September 14, 2026.
- AIUM. Practice Parameter for the Performance of an Ultrasound Examination of the Abdomen and/or Retroperitoneum (2017 revision)The adult transmit frequency range of 4 to 6 MHz and the curved or linear transducer choice. The 2026 revision dropped the frequency line, so the number is cited to the 2017 document. Accessed September 14, 2026.
- American College of Emergency Physicians. Sonoguide: GallbladderThe 3 mm wall limit and how to measure it, the 6 mm duct limit with its post-surgical caveat, the definition and yield of the sonographic Murphy sign, the decubitus repositioning test, and the colour Doppler manoeuvre at the porta hepatis. Accessed September 14, 2026.
- Gupta P, Marodia Y, Bansal A, et al. Imaging-based algorithmic approach to gallbladder wall thickening. World Journal of Gastroenterology, 2020The peer-reviewed anchor for a 3 mm upper limit, the measured normal mean of 2.6 plus or minus 1.6 mm, and the systemic causes of a thick wall that have nothing to do with the gallbladder. Accessed September 14, 2026.
- Murphy MC, Gibney B, Gillespie C, Hynes J, Bolster F. Gallstones top to toe: what the radiologist needs to know. Insights into Imaging, 2020That gallstones are echogenic and shadow posteriorly whatever their composition. Accessed September 14, 2026.
- Shea JA, Berlin JA, Escarce JJ, et al. Revised estimates of diagnostic test sensitivity and specificity in suspected biliary tract disease. Archives of Internal Medicine, 1994Both the unadjusted and the verification-bias-adjusted accuracy of ultrasound for gallstones. Accessed September 14, 2026.
- Pisano M, Allievi N, Gurusamy K, et al. 2020 WSES updated guidelines for the diagnosis and treatment of acute calculus cholecystitis. World Journal of Emergency Surgery, 2020That ultrasound is the preferred initial imaging technique, and the pooled sensitivity and specificity for acute cholecystitis. Accessed September 14, 2026.
- Rizvi A, Sethi A, Poneros J, Visrodia KH. Does incidentally detected common bile duct dilation need evaluation? Cleveland Clinic Journal of Medicine, 2022The published 6 to 8 mm range for the duct, the post-cholecystectomy figure, and the explicit statement that the evidence for an age adjustment varies. Accessed September 14, 2026.
- Horrow MM, Horrow JC, Niakosari A, Kirby CL, Rosenberg HK. Is age associated with size of adult extrahepatic bile duct: sonographic study. Radiology, 2001The negative result on the age adjustment, quoted alongside the rule it contradicts. Accessed September 14, 2026.
- Lobo V, Hunter-Behrend M, Cullnan E, et al. Caudal edge of the liver in the RUQ view is the most sensitive area for free fluid on the FAST exam. Western Journal of Emergency Medicine, 2017That fluid pools in the most dependent spaces in a supine patient, and that the caudal liver edge outperforms the pouch itself. Accessed September 14, 2026.
- Branney SW, Wolfe RE, Moore EE, et al. Quantitative sensitivity of ultrasound in detecting free intraperitoneal fluid. Journal of Trauma, 1995The measured detection threshold in this window: a mean of 619 mL, with only one in ten readers seeing less than 400 mL. Accessed September 14, 2026.
- Suresult. D3Ultra convex, linear and phased handheld ultrasound, product pageThe published specification column in the device card, and the current price. Accessed September 14, 2026.
- Suresult. C5SH 64-channel convex ultrasound probe with colour Doppler, product pageThe published specification and the current price of the convex-only alternative. Accessed September 14, 2026.
Every frame on this page was recorded on a Suresult probe: most by Suresult’s clinical reference library, figure 1 by a clinician who uses the device and shared the scan. Nothing comes from a third-party image bank. Figures 1 and 2 were recorded on named current hardware and the model is stated. Frames 3 to 9 come from the 2017 to 2020 clinical reference library, where the device model was not recorded; those captures predate the current product line and are described as a Suresult wireless convex probe rather than being assigned a model. The finding labels on the reference-library frames are the labels the library itself recorded. No frame has been retouched or relabelled. Two are cropped, and both captions say so: figure 2 is cropped to the scan panel of the tablet recording, and figure 4 reached the library as an export already cropped on both edges.
Convex depth, or a head that carries three geometries?
The gallbladder sits ten centimetres down through liver, and the hepatorenal recess sits deeper still. Those two depths settle the array on their own: convex, at 160 to 200 mm, with nothing a linear probe can contribute. What they do not settle is how much else the same head is expected to reach in a normal week. Describe the scans that actually fill yours and I will send back the reasoning along with the recommendation, including the case for buying nothing yet.
