Radiology glossary

Gallstones — What It Means on Your Report

Part of: Abdomen findings, explained

Full explainer: Gallstones — What It Means on Your Report

Hardened deposits have formed inside the gallbladder — the small pouch beneath the liver that stores bile for digestion. Gallstones form when bile's components (mainly cholesterol or bilirubin) crystallize, much like rock candy forming in a sugar solution, and they range from grains of sand to a golf ball. They are extraordinarily common — a large share of adults have them — and most never cause a single symptom: so-called “silent” gallstones are often found incidentally on imaging done for other reasons. Trouble starts when a stone blocks the gallbladder's outlet or lodges in the bile duct, which can cause the gallbladder to become inflamed (cholecystitis) or block bile flow. The classic symptom is biliary colic: intense upper-right abdominal pain, often after a fatty meal, sometimes with nausea. The report typically notes the stones' size and number, whether the gallbladder wall looks thickened or inflamed, and whether the bile duct is dilated. Silent stones and symptomatic stones are managed very differently — which is why your symptoms matter more than the stones' mere presence.

What it means on MRI

MRI — specifically MRCP, which images the bile ducts — is the specialist test for gallstone questions that ultrasound cannot answer: stones lodged in the bile duct rather than the gallbladder, the exact anatomy of the biliary tree, or inflammation complications. It shows the ducts in beautiful detail without radiation or contrast. It is a problem-solving test used when ultrasound suggests duct involvement or when surgery is being planned, not the first test for gallbladder stones.

What radiologists look at next

For gallstones, the sonographer or radiologist documents the stones' number and size, confirms they move with gravity (distinguishing true stones from polyps stuck to the wall), and measures the gallbladder wall thickness — thickening suggests inflammation. They check for secondary signs of trouble: fluid around the gallbladder, a stone impacted in the neck, dilation of the bile duct suggesting a stone downstream, and tenderness when the probe presses the gallbladder. The overall impression distinguishes simple silent stones from an inflamed or obstructed gallbladder, which is the distinction your doctor needs.

Where it commonly shows up

• gallbladder
• right upper abdomen
• biliary tract
• cystic duct

Questions to ask your doctor

• Are my gallstones causing my symptoms, or are they silent?
• Is the gallbladder inflamed?
• Is the bile duct dilated or blocked?
• Do the stones need treatment, or just monitoring?
• What symptoms should prompt urgent care?

Common questions

What does a gallbladder attack feel like?

Typically intense pain in the upper-right abdomen, often starting within an hour or two of a fatty meal, sometimes radiating to the right shoulder or back, with nausea. Attacks can last from minutes to hours. Fever, persistent severe pain, or yellowing of the skin or eyes suggests complications and needs prompt evaluation.

Do silent gallstones need treatment?

Usually not — most people with gallstones never develop symptoms, and medical guidance generally recommends leaving silent stones alone rather than removing a healthy-behaving gallbladder preventively. The exception is certain higher-risk situations your doctor can identify. If you have no symptoms, the usual plan is simply awareness.

Can gallstones go away on their own?

Small stones occasionally pass, but established gallstones rarely dissolve on their own. Certain medications can dissolve cholesterol stones in selected patients, but they work slowly, only for specific stone types, and stones often recur. Your doctor can explain whether that approach fits your situation or whether monitoring is the plan.

Related conditions

• Fatty Liver — What It Means on Your Report
• Mass — What It Means on Your Report
• Liver Cyst — What It Means on Your Report