Gallbladder PoCUS: What does the evidence actually say?

Right upper quadrant pain is one of the most common ED and urgent care presentations. When time matters, bedside PoCUS can meaningfully change decision-making.

For gallstones (cholelithiasis):

Bedside PoCUS performs extremely well.

Meta-analytic data show ~94% sensitivity and ~93% specificity, making it a reliable first-line diagnostic tool at the bedside.

For acute cholecystitis:

PoCUS shines as a rule-in test.

While sensitivity is moderate, specificity is high, especially when multiple supportive signs are present:

• Sonographic Murphy sign

• Gallbladder wall thickening (>3 mm)

• Pericholecystic fluid

• Gallbladder distension ± hyperemia

Clinical takeaway:

PoCUS helps risk-stratify patients, prioritize formal imaging or surgical consults, and accelerate care when radiology is delayed—but should always be interpreted in clinical context.