C  2012, Wiley Periodicals, Inc. RESEARCH FROM THE UNIVERSITY OF ALABAMA AT BIRMINGHAM Does the Routine Echocardiographic Exam Have a Role in the Detection and Evaluation of Cholelithiasis and Gallbladder Wall Thickening? David D. Daly Jr., M.D., Haytham El-Shurafa, M.D., Navin C. Nanda, M.D., Bhavin Dumaswala, M.B.B.S., Komal Dumaswala, M.B.B.S., Nilay Kumar, M.D., and Ferit Onur Mutluer, M.D. Division of Cardiovascular Diseases, University of Alabama at Birmingham, Birmingham, Alabama Cholelithiasis is a very common disease in the United States. Most cases remain asymptomatic but a fraction of these patients can develop serious complications such as cholecystitis which may lead to gallbladder perforation and gallbladder cancer which is much less common. Here, we present three cases of cholelithiasis where transthoracic echocardiography was performed routinely. In each case, echocardiography detected cholelithiasis which prompted three-dimensional (3D) echocardiographic evaluation. Three-dimensional echocardiography allowed for more comprehensive examination of the gallbladder shape, size, and wall thickening and the measurement and composition of the stones in three dimensions, measurement of stone volumes, and minimized shadowing produced by stone calcifications. These cases suggest that routine echocardiography has value in detecting gallstones and that 3D echocardiography has incremental value over two-dimensional echocardiography due to pyramidal data sets which allow sequential slicing through the gallbladder and full gallbladder examination without a technologist who is trained in gallbladder imaging. These pyramidal data sets can be further viewed and cropped by a radiologist specialized in abdominal ultrasound. Key words: real time three-dimensional transthoracic echocardiography, three-dimensional echocar- diography, two-dimensional transthoracic echocardiography, three-dimensional ultrasound, cholelithi- asis, gallstones, cholecystitis, gallbladder wall thickening Cholelithiasis is a common problem with up to 20–25 million adults with gallstones in the United States. 1 Most patients with gallstones are asymp- tomatic but biliary colic develops in 1–4% annu- ally and cholecystitis develops in 20% of these asymptomatic patients if they are left untreated. Cholecystitis results in thickening (greater than 5 mm on gallbladder ultrasound) and edema of the gallbladder wall with or without pericholecys- tic fluid collection and rarely perforation of the gallbladder. 2 Gallstones, which consist of varying amounts of calcium bilirubinate and cholesterol, also place patients at increased risk for gallbladder cancer as 1–2% of patients who undergo open cholecystectomy for symptomatic gallstones are found to have cancer and 75% of patients with gallbladder cancer have had stones. Both stone size and duration are thought to play a role in cancer formation. 3 Address for correspondence and reprint requests: Navin C. Nanda, M.D., University of Alabama at Birmingham, Heart Sta- tion SW/S102, 619 19th Street South, Birmingham, AL 35249. Fax: 205-934-6747; E-mail: nanda@uab.edu We report three cases of cholelithiasis where echocardiography was performed as part of rou- tine cardiac workup and cholelithiasis was noted on two-dimensional echocardiography (2DE) per- formed in a standard manner using a 3.5 MHz adult probe and a Philips iE33 ultrasound sys- tem (Bothell, WA, USA). This prompted eval- uation by three-dimensional echocardiography (3DE) using the same ultrasound system and a 4 MHz matrix array probe (Phillips iE33 ultrasound system) and this revealed additional informa- tion about gallbladder wall thickening and stone size and composition in these patients evaluated only by an echocardiography technologist and cardiologist. 4 Case Description: Case 1: A 49-year-old male with a history of primary biliary cirrhosis, esophageal varices, and sponta- neous bacterial peritonitis underwent liver trans- plant evaluation for decompensated cirrhosis. A routine 2DE was done as part of preoperative cardiac workup revealing normal left and right (Echocardiography 991 DOI: 10.1111/j.1540-8175.2012.01777.x 2012;29:991-996)