A middle-aged patient presented with lower mid chest pain radiating to the back. Initial cardiac testing was unremarkable as was an ultrasound of the abdominal aorta. The gallbladder was then visualized and noted to be full of sludge and stones. In the image, the gallbladder is so full of sludge and stones that it was initially almost unrecognizable.

The patient was not tender over the gallbladder, nor was there thickening of the wall or pericholecystic fluid. The CBD measured within normal limits at 3.5mm. The patients lipase was markedly elevated and was diagnosed with biliary pancreatitis and admitted to the surgical team for further management.

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