Ultrasound of the Gallbladder-An Update on Measurements, Reference Values, Variants and Frequent Pathologies: A...

Objective: We aimed to provide an update on ultrasound measurements of the gallbladder with studies focusing on measurement techniques, reference values, and influencing factors. Anatomical anomalies and common pathological findings are discussed together with their clinical impact. Methods: A literature search was performed for ultrasound studies in healthy subjects. Relevant data published between 2010 and March 2025 were extracted and evaluated. Possible clinical implications are discussed. Results: Many factors influence gallbladder size and wall thickness, as the gallbladder is a highly functional organ. Diabetes and obesity have been proven to increase gallbladder volume and wall thickness. A normal gallbladder wall should be echogenic with one layer and a thickness < 3 mm. Gallbladder size is variable and can achieve values above 10 × 4 × 4 cm, especially with increasing age. Gallbladders with maximal diameters below 3.5 cm are referred to as micro-gallbladders. Calculating gallbladder volume is reserved for special issues, achieving the best inter- and intra-observer variability with the ellipsoid formula. Clinical relevance and work-up of common pathological findings like wall thickening, gallbladder polyps, and stones are discussed.