The gallbladder is markedly distended and contains a large volume of mobile echogenic material in keeping with sludge. This extends into the neck of the gallbladder and the cystic duct. Cholelithiasis is demonstrated. The gallbladder wall is thickened measuring 6 mm. There is a small volume of pericholecystic free fluid. Murphy's sign positive.
The common bile duct is dilated measuring up to 13 mm at the head of pancreas. No choledocholithiasis detected. There is also intrahepatic biliary dilatation.
Conclusion:
Markedly distended, tender gallbladder with cholelithiasis and a large amount of sludge. The appearances are in keeping with acute cholecystitis.