Non-vertebral causes such as the presence of gallstones should be considered in patients with back pain. Physicians should be aware of atypical manifestations of common diseases, so as to avoid diagnostic delays. Gallbladder disorders should be taken into account in patients with dull, undefined right back pain, despite a normal physical examination. Abdominal ultrasound should be chosen as the first diagnostic procedure when considering gallstones, since CT scans have a very low sensitivity for their detection. In a patient with a typical clinical report of biliary colic and a negative abdominal ultrasound, an endoscopic ultrasound may be carried out in order to rule out biliary microlithiasis. 1).
1)
Bobé-Armant F, Buil-Arasanz ME, Trubat-Muñoz G, Llor-Vilà C, Vicente-Guillen
V. Cholelithiasis presented as chronic right back pain. J Family Med Prim Care.
2014 Oct-Dec;3(4):458-60. doi: 10.4103/2249-4863.148150. PubMed PMID: 25657967;
PubMed Central PMCID: PMC4311366.