The Case of the Radiolucent Gallstones

(This post was first published on on August 17, 2016)

This week I’m joined by Jess Mason of EMRAP HD and This Won’t Hurt a Bit, two podcasts that if you haven’t subscribed to yet, you must!

We talk about a case where the CT scan missed a veritable hacksack of gallstones within the RUQ.


  1. Great case Jacob !!
    Was wondering about the comment you made about the 10% mortality rate in elderly with abd pain..
    Do you have the reference ? My guess would be that in almost all of these cases ultrasound would get you the diagnosis or at least get a positive scan to send you in the right direction. Thereby avoiding lots of radiation.
    Where I work ( Netherlands) an ultraound like you showed in the case would be the definitive test , no CT needed. Would you agree ?

    Love to hear your thoughts!


    1. Yes, I would tend to agree. In this particular case, if I had been able to get the US before the CT I may not have gotten the CT scan. I work with residents (not all of them EM), and the CT scan was surprisingly done faster than I could see the patient. Here’s the reference regarding the 10% mortality rate: It quotes an older study, but I’ve seen that 10% mortality rate mentioned a bit. If you find a more recent one, I’d love to hear it!

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