Right Upper Quadrant Ultrasound

A right upper quadrant ultrasound is done to evaluate symptoms that are thought to arise from structures in the right upper quadrant of the abdomen.  The abdomen is broken down into right upper, right lower, left upper and left lower quadrants.    It helps with the diagnosis to know which quadrant the symptoms are coming from.

What organs does a right upper quadrant ultrasound include?

A right upper quadrant ultrasound usually includes evaluation of the liver, the gallbladder, the bile ducts, the right kidney, and pancreas.  These organs and structures can be responsible for pain in the right upper quadrant.   Ultrasound is a great way to start the evaluation of your symptoms.

How does a right upper quadrant ultrasound work?

Ultrasound uses no radiation.  Ultrasound uses sound waves to produce pictures of structures inside your body.  Ultrasound is relatively cheap and quick.  Right upper quadrant ultrasounds are done by specially trained technologists who will take the pictures.   A specially trained doctor called a radiologist will interpret the images.

What are some common conditions that a right upper quadrant ultrasound can diagnose?

Gallbladder

Right upper quadrant ultrasound will identify common conditions which are responsible for symptoms arising from the right upper quadrant.  Perhaps the most common is stones in the gallbladder.   Stones in the gallbladder can cause pain and result in an inflamed gallbladder (cholecystitis).

Kidneys

Right upper quadrant ultrasound can show kidney stones.  The test can also show when the kidney is blocked by a passing stone.  This is called hydronephrosis.  Ultrasound can not always show the stone blocking the kidney so a CT scan is often done.

Liver

Right upper quadrant ultrasound will show liver abnormalities.  We sometimes identify masses.  We also see fatty liver which can be associated with inflammation (steatohepatitis).  This is serious because it can progress to cirrhosis.

Bile ducts

Dilated bile ducts can also be seen from a variety of causes.  Bile ducts carry the bile from the liver into the intestine to help with digestion.  Bile ducts can get blocked from stones or masses.  We can sometimes identify the cause of the dilated bile ducts.  At times, MRI of the abdomen will be needed to identify the cause.

Pancreas

Abnormalities of the pancreas can sometimes be identified.  Unfortunately, we often do not get a great look at the pancreas because of its position deep in the abdomen and surrounding bowel.   When we do see findings, it is usually a cyst or mass.  We usually don’t see pancreatitis which is an inflamed pancreas.   This can be diagnosed with lab tests and CT.

Accumulation of fluid

Right upper quadrant ultrasound can show us abnormal accumulation of fluid in the right upper quadrant and sometimes in the lower chest.  This is called ascites in the abdomen and pleural effusion in the chest.  Ascites can form from many causes, but is common with cirrhosis, cancer, and inflammatory conditions.  Ultrasound can sometimes show us the cause of the ascites.

What are some disadvantages of ultrasound?

Unlike some other imaging tests, ultrasound is dependent on the skill and experience of the technologist who does the test.   Ultrasound is not as good for large patients or those who have a lot of gas in the bowels.  Ultrasound is also not great at telling us what some abnormalities are like masses. Ultrasound can confuse normal structures like bowel loops for abnormality.

Right upper quadrant ultrasound is however a great way of evaluating for a cause of symptoms.  It shows us many common abnormalities in this region of the abdomen.  It is one of the best tests for the gallbladder which is a common cause of right upper quadrant abdominal pain.  It is relatively quick, cheap and uses no radiation.