A patient story
When Emma, a 42-year-old office worker, came to LSDC Clinic complaining of persistent bloating and intermittent abdominal discomfort, she assumed that an abdominal ultrasound would give a complete answer. She imagined the scan as a magical “window into her belly,” able to reveal anything from subtle intestinal inflammation to early organ problems.
After her scan, Emma was surprised to learn that while the ultrasound provided excellent images of her liver, kidneys, and gallbladder, it couldn’t show everything. Some structures and conditions simply elude even the most advanced ultrasound machines. Her consultant explained what could and couldn’t be visualised, helping her understand the next steps for diagnosis and care.
This scenario is common. Many patients assume that an ultrasound provides a full picture, but its strengths and limitations are very specific. Understanding them can help you interpret results and know when further testing is necessary.
What Cannot Be Seen During an Abdominal Ultrasound
Structures/Conditions | Why Ultrasound May Be Limited |
|---|---|
Intestinal mucosa and early bowel disease | Gas in the intestines obstructs sound waves; subtle mucosal changes (e.g., Crohn’s ulcers or early colitis) cannot be reliably detected. Endoscopy or MRI may be required. |
Adhesions or scar tissue | Ultrasound cannot visualise fibrous bands directly. Secondary signs like altered bowel movement or dilatation might hint at adhesions. |
Microscopic gallbladder or liver disease | Functional or very small inflammatory changes are invisible; stones and obvious inflammation are visible, but subtle cellular-level disease is not. |
Small peritoneal deposits or early cancers | Tiny lesions, particularly those hidden behind bowel gas or fat, may be missed. CT or MRI is often required for high-risk cases. |
Pancreas | The pancreas is retroperitoneal and often obscured by gas; small tumours or subtle inflammation may go undetected, especially in overweight patients. |
Retroperitoneal structures | Kidneys and aorta are usually visualised, but structures behind bowel loops or deep in fat can be partially obscured. |
Deep pelvic organs | In women, the ovaries or uterus may be hard to assess unless the bladder is full; in men, the prostate is not fully visible. |
Bone structures | Ultrasound cannot penetrate bone, so fractures or bony abnormalities require X-ray or CT. |
Small or deep blood vessels | Major vessels can be assessed, but small or deeply located vessels may not be fully evaluated. |
Why Some Conditions Are Missed
In practice, the limitations above often relate to physical barriers rather than equipment or operator skill. Even in a clinic like LSDC, where imaging is performed using state-of-the-art machines and by experienced specialists, ultrasound is fundamentally constrained by:
Bowel gas – sound waves cannot pass through air
Patient body habitus – excess fat can reduce image clarity
Depth of organ – very deep structures may be partially obscured
This means that a normal ultrasound result does not always mean everything is fine, especially if symptoms persist. Some conditions simply require complementary imaging or endoscopic evaluation.
When Further Testing May Be Needed
If your symptoms suggest underlying disease that ultrasound cannot reliably detect, your clinician may recommend:
CT scan – excellent for detecting small lesions, bowel wall thickening, or complex anatomy
MRI – ideal for soft tissue contrast, early inflammatory changes, and detailed liver or pancreatic imaging
Endoscopy or colonoscopy – required to assess the mucosa of the stomach, small intestine, or colon
Functional studies – such as motility testing for bowel or gallbladder function
At LSDC Clinic, consultants combine the initial ultrasound findings with clinical assessment to decide whether further imaging is warranted, ensuring patients receive accurate diagnosis and timely treatment.
Common Misunderstandings Patients Have
Many patients are surprised to learn that ultrasound has blind spots. Typical misconceptions include:
“Ultrasound will show inflammatory bowel disease.”
It can sometimes detect bowel wall thickening, but not mucosal inflammation or early disease.“It can see adhesions or scar tissue.”
Adhesions are invisible; secondary signs may hint at their presence but are not conclusive.“Microscopic liver or gallbladder disease will be detected.”
Only larger changes or stones are visible. Functional or cellular-level issues are missed.“A normal scan means nothing is wrong.”
Ultrasound is one part of the assessment; persistent symptoms may require further testing.
Book A Consultation
If you’ve been advised to undergo a gastroscopy, colonoscopy, or would like a second opinion, we invite you to book a consultation with one of our specialists. Our team will review your symptoms, medical history, and determine the most appropriate diagnostic pathway for you.
Contact us