Sonographic Murphy sign is defined as maximal abdominal tenderness from pressure of the ultrasound probe over the visualized gallbladder 1,2. It is a sign of local inflammation around the gallbladder along with right upper quadrant pain, tenderness, and/or a mass 2.
It is one of the most important sonographic signs of cholecystitis and when combined with the presence or absence of cholelithiasis it has a high positive and negative predictive value respectively 3.
Sonographic Murphy sign is the radiological correlate of the clinical Murphy sign, which is elicited by deep palpation of the right hypochondrium followed by the examiner asking the patient to inspire. If the patient's breath abruptly stops, then it is a positive Murphy sign 5,6.
History and etymology
John Benjamin Murphy (1857–1916), was an American surgeon, regarded by his peers as a surgeon without equal, in view of his mastery of general surgery, orthopedics, neurosurgery and cardiothoracic surgery. He is best remembered for his eponymous sign 4,5.
- 1. Bree RL. Further observations on the usefulness of the sonographic Murphy sign in the evaluation of suspected acute cholecystitis. J Clin Ultrasound. 1995;23 (3): 169-72. Pubmed citation
- 2. Kiewiet JJ, Leeuwenburgh MM, Bipat S et-al. A systematic review and meta-analysis of diagnostic performance of imaging in acute cholecystitis. Radiology. 2012;264 (3): 708-20. Radiology (full text) - doi:10.1148/radiol.12111561 - Pubmed citation
- 3. Noble VE, Liteplo AS, Nelson BP et-al. The impact of analgesia on the diagnostic accuracy of the sonographic Murphy's sign. Eur J Emerg Med. 2010;17 (2): 80-3. doi:10.1097/MEJ.0b013e32832e9627 - Pubmed citation
- 4. Musana K, Yale SH. John Benjamin Murphy (1857 - 1916). (2005) Clinical medicine & research. 3 (2): 110-2. Pubmed
- 5. Musana KA, Yale SH. Murphy's Sign. (2005) Clinical medicine & research. 3 (3): 132. Pubmed
- 6. Jackson PG, Evans SRT. 2017. Sabiston Textbook of Surgery. 20th ed. New York (NY). Chapter 54, The biliary system, p.1482-1519.