Sonographic Murphy sign

A Sonographic Murphy sign refers to a finding when performing diagnostic medical sonography. It is different from the Murphy sign found on physical examination, but both signs are associated with cholecystitis[1] When the sonographer presses directly over the gallbladder, and the patient expresses pain, more than when the sonographer presses anywhere else, this is said to be a positive sonographic Murphy sign.[2][3][4]

Differences

A Sonographic Murphy sign is different from a Murphy sign on physical examination of the abdomen in three ways:

  1. Unlike the physician doing an abdominal exam, the sonographer can see the exact position of the gallbladder, which varies somewhat from one person to the next, and with the depth of inspiration.
  2. The patient usually takes a breath and holds it during scanning, while the traditional Murphy sign is elicited while the patient is inhaling, and
  3. The sonographer is usually asking the patient about the pain, while the traditional Murphy sign relies on an involuntary reaction - stopping inspiration when the gallbladder slides under the examining hand.[5][6]

References

  1. ↑ Ralls, PW; Colletti, PM; Lapin, SA; Chandrasoma, P; Boswell WD, Jr; Ngo, C; Radin, DR; Halls, JM (June 1985). "Real-time sonography in suspected acute cholecystitis. Prospective evaluation of primary and secondary signs.". Radiology. 155 (3): 767–71. doi:10.1148/radiology.155.3.3890007. PMID 3890007.
  2. ↑ Simeone, JF; Brink, JA; Mueller, PR; Compton, C; Hahn, PF; Saini, S; Silverman, SG; Tung, G; Ferrucci, JT (February 1989). "The sonographic diagnosis of acute gangrenous cholecystitis: importance of the Murphy sign.". AJR. American journal of roentgenology. 152 (2): 289–90. doi:10.2214/ajr.152.2.289. PMID 2643262.
  3. ↑ Rumack, Carol M., ed. (2011). Diagnostic ultrasound (4th ed.). Philadelphia, PA: Elsevier/Mosby. p. 203. ISBN 9780323053976.
  4. ↑ "Acute Calculous Cholecystitis". ultrasoundtraining.com. Retrieved May 26, 2011.
  5. ↑ Urbano FL and Carroll M, Hospital Physician, November 2000: p51-52 (includes a description of the Murphy sign, and an erroneous description of the sonographic Murphy sign)
  6. ↑ Orient JM, Sapira's Art & Science of Bedside Diagnosis 3e, 2005, Lippincott Williams & Wilkins, p461 (describes one method in detail for eliciting the Murphy sign)
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