The gallbladder in this patient presented double layered wall with focal mineralization or potential gas penetration of the wall with aggressive adhesion pattern at the neck. Dilated gallbladder neck and suspended immobile debris were also noted. This is consistent with gallbladder mucocele and secondary inflammation. The patient had a positive Murphy’s sign which was reported to the clinician by the sonographer. No free fluid was noted at this time. The common bile duct did appear slightly dilated and occasional echogenic structure was noted within the common bile duct, which may result in biliary calculi. The gallbladder measured 4 x 3 cm and was significantly inflamed. Surgical intervention with cholecystectomy and common bile duct lavage would be warranted. There is a minor possibility that bile duct deviation would be required. The common bile duct proximal to the duodenal papilla measured 0.32 cm. However, an adhesion pattern was noted in this region. The gallbladder wall measured 0.55 cm. The liver itself presented increased portal markings with heterogenous changes. This is consistent with cholangiohepatitis pattern.