The utility of plain film in the diagnosis of gallbladder disease is extremely limited. Most gallstones are insufficiently calcified to be visualized on the plain film, (only about 10% are visualized) and porcelain gallbladder is relatively rare.
When the plain film is ordered to evaluate other disease and either calcified gallstomes ot porcelain gallbladder are recognized this is an important contribution.
82168.8s allbladder gallstones cholelithiasis multiple small calcified right upper quadrant plain film abdomen plain x-ray Courtesy Ashley Davidoff MD copyright 2008 all rights reserved
Emphysematous cholecystitis is sometimes best and most easily diagnosed by plain film. The image is pathognomonic. It is a relatively uncommon disease and is suspected in a diabetic patient with right upper quadrant pain and who is extremely ill.
gallbladder emphysematous cholecystitis X-ray Courtesy Barbara Banner MD 11928.8s
Another uncommon disease that may be diagnosed with plain film is gallbladder ileus. The finding on plain film of small bowel obstruction with a calcified gallstone at the transition point with air in the biliary system is characteristic