Murphy's Sign (Sweeney's Sign)

General Ultrasound • Gallbladder • Clinical Signs

Murphy's Sign (Sweeney's Sign)

Clinical Elicitation, Sonographic Correlation, and Significance in Gallbladder Disease

Hepatobiliary Ultrasound General Sonography Updated 2026 Educational Reference

Definition → Murphy's sign, also known as Sweeney's sign, is a clinical sign used primarily to assess for gallbladder inflammation, particularly acute cholecystitis. A positive sign occurs when palpation of the right upper quadrant during inspiration produces significant pain and causes the patient to abruptly stop or interrupt inspiration.

How is it Elicited? → The examiner places the fingers or hand beneath the right costal margin, usually near the midclavicular line, and asks the patient to take a deep breath. During inspiration, the diaphragm moves downward and the gallbladder descends toward the examiner's hand. If this maneuver produces marked pain and the patient suddenly stops inspiration, the test is considered positive.

Positive Murphy's Sign → A positive Murphy's sign is characterized by localized right upper quadrant tenderness associated with inspiratory arrest. The finding suggests gallbladder inflammation and may support the clinical diagnosis of acute cholecystitis, but it should always be interpreted together with the clinical presentation and imaging findings.

Sweeney's Sign → Sweeney's sign is used as a synonym for Murphy's sign. Therefore, a positive Sweeney's sign describes the same clinical response: right upper quadrant pain during inspiration with inspiratory arrest when the inflamed gallbladder comes into contact with the examiner's hand.

Ultrasound Murphy's Sign → During ultrasound examination, the transducer is positioned directly over the gallbladder and gentle pressure is applied. A sonographic Murphy's sign is considered positive when the patient experiences maximal tenderness directly beneath the ultrasound probe over the gallbladder. This finding is particularly useful when correlated with gallbladder wall thickening, distension, stones, sludge, or pericholecystic fluid.

Clinical Importance → Murphy's sign is an important bedside finding in patients with suspected acute cholecystitis. It helps localize symptoms to the gallbladder, but a positive or negative sign alone does not establish or exclude the diagnosis. Clinical examination, laboratory findings, and imaging should be considered together.

Sonographic Correlation → In suspected acute cholecystitis, ultrasound may demonstrate gallstones, gallbladder distension, wall thickening, pericholecystic fluid, sludge, hyperemia of the gallbladder wall, and a positive sonographic Murphy's sign. The combination of appropriate clinical findings and characteristic sonographic abnormalities increases diagnostic confidence.

Positive vs Negative → Positive Murphy's Sign → Right upper quadrant pain + inspiratory arrest.
Negative Murphy's Sign → Deep inspiration can be completed without characteristic gallbladder tenderness.
Sonographic Murphy's Sign → Maximal tenderness directly beneath the ultrasound transducer over the gallbladder.

Commonly Associated Conditions → Murphy's sign is most classically associated with acute cholecystitis. Similar right upper quadrant tenderness, however, may occur with other hepatobiliary or adjacent abdominal conditions, so the sign is not completely specific for acute cholecystitis.

Important Ultrasound Findings → Gallstones → Echogenic calculi with posterior acoustic shadowing.
Gallbladder Wall Thickening → May accompany inflammation but is nonspecific.
Gallbladder Distension → May occur with cystic duct obstruction.
Pericholecystic Fluid → Supports inflammatory change when appropriately interpreted.
Wall Hyperemia → May be demonstrated with Doppler in inflammation.
Sonographic Murphy's Sign → Maximal tenderness directly over the gallbladder.

Clinical Mechanism → During deep inspiration, the diaphragm descends and the gallbladder moves downward toward the examiner's hand or ultrasound transducer. When the gallbladder is inflamed, this contact can produce localized pain, causing the patient to interrupt inspiration.

Key Learning Point → Murphy's Sign = Sweeney's Sign
Positive Clinical Sign = RUQ pain + inspiratory arrest
Sonographic Murphy's Sign = Maximal tenderness directly beneath the probe over the gallbladder
Most Important Association = Acute cholecystitis

Did You Know? → John Benjamin Murphy's influence extended beyond the Murphy sign. He was an important figure in the development of modern American surgery, particularly through his emphasis on early intervention, clinical observation, surgical innovation, and practical teaching. The American College of Surgeons recognizes him as one of the important figures in its early history.

Historical Summary → John Benjamin Murphy → American surgeon
Born → December 21, 1857, Appleton, Wisconsin
Medical Degree → Rush Medical College, 1879
Major Surgical Center → Chicago
Chief of Surgery → Mercy Hospital, Chicago
Famous For → Murphy's sign + major surgical innovations
American Medical Association → President, 1911–1912
Died → August 11, 1916