title: Extrabiliary Pathology Identified by Right Upper Quadrant Abdominal Ultrasound in Emergency Department Patients.
abstract: BACKGROUND
  The effectiveness of point of care (POC) right upper quadrant ultrasound (RUQ US) in the diagnosis of biliary disease has been well studied. Extrabiliary pathology that might remain undetected in the course of typical, focused POC RUQ US has not been directly examined.
  
  
  OBJECTIVE
  Our objective was to determine the prevalence and clinical significance of extrabiliary findings (EBFs) seen on radiology-performed, comprehensive RUQ US.
  
  
  METHODS
  We conducted a retrospective review of all adult patients undergoing radiology-performed RUQ US in the emergency department (ED) between January 2007 and April 2012. Ultrasound findings and contemporaneous laboratory values were collected. EBFs were identified and further classified by clinical significance.
  
  
  RESULTS
  A total of 1579 charts were included, demonstrating a total of 1030 EBFs, with 747 (47.3% [95% confidence interval {CI}, 44.8-49.8%]) patients demonstrating ≥ 1 EBF. Of these EBFs, 184 were classified as clinically significant (CSEBFs) and 150 (9.5% [95% CI, 8.1-11.0%]) patients had ≥ 1 CSEBF. A total of 50 unspecified masses were seen in 47 (3.0% [95% CI, 2.1-3.8%]) patients, with 8 (0.5%) representing a previously undiagnosed malignancy.
  
  
  CONCLUSIONS
  CSEBFs were seen in < 10% of ED patients undergoing comprehensive RUQ US. Nonspecific masses were seen in 3% of patients, but < 1% of patients were found to have a new malignancy.
authors.affiliation: Department of Emergency Medicine, Wellspan York Hospital, York, Pennsylvania.
authors.forename: Brent A
authors.initials: BA
authors.lastname: Becker
authors.affiliation: Department of Emergency Medicine, Wellspan York Hospital, York, Pennsylvania.
authors.forename: William A
authors.initials: WA
authors.lastname: Fields
authors.affiliation: Department of Emergency Medicine, Memorial Hospital, York, Pennsylvania.
authors.forename: Lauren
authors.initials: L
authors.lastname: Pfisterer
authors.affiliation: Department of Emergency Medicine, Wellspan York Hospital, York, Pennsylvania.
authors.forename: Robert M
authors.initials: RM
authors.lastname: Stuntz
authors.affiliation: Department of Emergency Medicine, Wellspan York Hospital, York, Pennsylvania.
authors.forename: Barbara A
authors.initials: BA
authors.lastname: Stahlman
authors.affiliation: Department of Emergency Medicine, Wellspan York Hospital, York, Pennsylvania.
authors.forename: Erik I
authors.initials: EI
authors.lastname: Kochert
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D004636:Emergency Service, Hospital; D005260:Female; D005705:Gallbladder Diseases / Q000000981:diagnostic imaging* / Q000453:epidemiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D019095:Point-of-Care Systems; D015995:Prevalence; D012189:Retrospective Studies; D014463:Ultrasonography; D014481:United States / Q000453:epidemiology; D055815:Young Adult
keywords: biliary; emergency department; extrabiliary; right upper quadrant; ultrasound