Errors and mistakes in the ultrasound diagnostics of the liver, gallbladder and bile ducts

Abstract

Ultrasonography is the most widespread imaging technique used in the diagnostics of the pathologies concerning the organs in the abdominal cavity. Similarly to other diagnostic tools, errors may occur in ultrasound examinations. They generally result from inappropriate techniques, which do not conform to current standards, or erroneous interpretation of obtained images. A significant portion of mistakes is caused by inappropriate quality of the apparatus, the presence of sonographic imaging artifacts, unfavorable anatomic variants or improper preparation of the patient for the examination. This article focuses on the examiner-related errors. They concern the evaluation of the liver size, echostructure and arterial and venous vascularization as well as inappropriate interpretation of the liver anatomic variants and the vascular and ductal structures localized inside of it. Furthermore, the article presents typical mistakes made during the diagnosis of the most common gallbladder and bile duct diseases. It also includes helpful data concerning differential diagnostics of the described pathologies of the liver, gallbladder and bile ducts. The article indicates the most frequent sources of mistakes as well as false negative and false positive examples which result from these errors. What is more, the norms used in the liver, gallbladder and bile duct evaluations are presented as well as some helpful guidelines referring to the exam techniques and image interpretation, which allows for reducing the error-making risk. The article has been prepared on the basis of the report published in 2005 by the Polish experts in the field of ultrasonography and extended with the latest findings obtained from the pertinent literature.

Perception of Clinicians about Diagnostic Radiological Errors in the University of Science and Technology Hospital, Sana'a - Yemen

“…Such errors could be due to the lack of operator's knowledge during history taking, physical examination or final reporting of the patient's condition. On the other hand, lack of operator's experience can lead to errors, including wrong selection of transducer or improper setup of organ-specific mode (11). Other non-human causes of errors include room light, either due to excessive light or to placing the ultrasound monitor opposite to a window, and noise.…”

“…In addition, other nearby devices can affect the performance of ultrasound such as electromagnetic devices. Errors due to the patient's condition can be either the presence of gases in the abdomen that may cause difficulty in reading and diagnosis, or lack of patient's cooperation such as the inability to take and hold breath, site tenderness, pain and wound that may affect the reading and diagnosis during ultrasound (11). It should be noted this study is limited by the small sample size, the low response rate of the study subjects and being conducted in one tertiary hospital.…”

Bile Duct Strictures Caused by Solid Masses: MR in Differential Diagnosis and as a Prognostic Tool to Plan the Endoscopic Treatment

“…In 3D MRCP the use of water as a natural contrast in duodenum and evaluation of both (maximum intensity projection) MIP and source cholangiopancreatographic images are the simplest methods to decrease the number of misdiagnoses in these cases [ 16 , 18 ]. The influence of bile duct dilatation and presence of gas and fluid in the duodenum on sensitivity in the diagnosis of localization and cause of biliary duct pathologies are also common in ultrasonography performed in most cases prior to magnetic resonance [ 19 , 20 ].…”

Gallbladder reporting and data system (GB-RADS) for risk stratification of gallbladder wall thickening on ultrasonography: an international expert consensus

“…Even though gallbladder wall thickening is a common finding on US, there are no existing reporting and risk stratification systems. This leads to significant variability in US reporting of gallbladder abnormalities [9]. This International Consensus was conducted to develop objective guidelines for reporting and risk stratification of gallbladder wall abnormalities in non-acute setting on US based on the existing literature and expert opinion.…”