Right upper quadrant ultrasound for pain is a quick way to assess the right upper abdomen. The test looks at the liver, gallbladder, bile ducts, right kidney and pancreas. Abnormalities of these structures and organs can lead to right upper quadrant abdominal pain.
Ultrasound uses high frequency sound waves to create images. The test is done by a specially trained technologist. The test is interpreted by a radiology doctor who will issue a report. Ultrasound is dependent on the skill of the technologist. Ultrasound can also be limited by obesity and if there are bowel loops in the way of the sound waves.
Perhaps the most common abnormality I see are of the gallbladder. Ultrasound is the best test for diagnosing gallstones and sludge. These can cause gallbladder attacks or biliary colic. An inflamed gallbladder or cholecystitis is also diagnosed with ultrasound. We may see a thickened gallbladder wall, stones, fluid around the gallbladder and pain when the technologist pushes on the gallbladder. Other abnormalities of the gallbladder like cancer can also be diagnosed.
Abnormalities of the right kidney can also be diagnosed. Kidney stones are seen as white bright spots with darkness shadowing from them. An obstructed kidney can cause right abdominal pain. Ultrasound will show a dilated collecting system and hydronephrosis. Often the cause of the hydronephrosis will not be apparent since this test will not look look at the ureter, which is the tube which goes from the kidney to the bladder. Stones in the ureter will most commonly block the kidney.
Abnormalities of the bile ducts will mostly be limited to dilated ducts. This means the bile ducts will be more visible and bigger than usual. This can mean that something is blocking them. It can be a stone or mass. Often additional testing is needed because ultrasound can not fully evaluate the bile ducts. MRI is best for that.
Abnormalities of the pancreas are also seen on right upper quadrant ultrasounds. This can include pancreatitis or inflamed pancreas. This diagnosis is better diagnosed with blood tests and CT however. Pancreatic masses can also be seen, such as cancer. Unfortunately, ultrasound often can not fully evaluate the pancreas because it is deep seated and because there are bowel loops in front of it.
Right upper quadrant ultrasound for pain is a quick survey of the right upper abdomen for causes of pain. It’s relatively inexpensive and does not use radiation. It is limited by the skill of the technologist. It is also limited by more fat tissue and bowel in the path of the ultrasound.
There are also some diagnosis which can not be made with ultrasound. Other blood lab testing or imaging tests are needed. That is why it’s important for your doctor to take a careful history, do a physical and order blood work. This in combination with imaging will lead to the best possibility of an accurate diagnosis.