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The patient presented for a RUQ ultrasound to evaluate persistent epigastric pain and suspected cholelithiasis. Imaging of the liver reveals a homogeneous parenchyma with no focal masses or intrahepatic biliary ductal dilation. The gallbladder appears distended with a thickened wall of 4mm, and a hyperechoic 1.2 cm mobile stone is noted in the neck with associated posterior acoustic shadowing. The common bile duct measures 5mm, which is within normal limits. Findings are consistent with acute cholecystitis. Correlation with CT scan of the abdomen and pelvis with intravenous contrast is recommended to further characterize the adjacent inflammatory changes and rule out perforation."