To the Editor.—
While we agree that ultrasound is a useful emergency procedure in the diagnosis of acute gallbladder disease, we have to take exception to several features in the article by Chandnani et al.First, although the images submitted do show cholelithiasis, measurement of the gallbladder using the centimeter markers included on the scans show the gallbladder to measure approximately 7×3.5 cm. This belies the 7 × 7.5-cm measurement mentioned in the paper and is within the range of normal provided in the references by the authors. To justify the diagnosis of hydrops, stones must be seen in the region of the gallbladder neck or cystic ducts. The stones shown by the authors lie free in the gallbladder lumen. Additionally, we agree with Leopold et al1 and Lawson2 that there is a wide range of normal gallbladder diameters, and use of these measurements to diagnose cystic duct
Flynn M, Kappelman N, Sanders RC. Ultrasound and Diagnosis of Hydrops of the Gallbladder. JAMA. 1977;238(7):582. doi:10.1001/jama.1977.03280070021012
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