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Introduction: Gallbladder disease is a common and escalating problem, particularly in the United States and other developed countries, where a variety of modifiable factors (including diet, alcohol consumption, and activity level) come into play. It is estimated that 20-25 million Americans have gallstones, representing 10-15% of the adult population. Of these, approximately 20% become symptomatic at some point, causing cholecystitis to account for 3-9% of hospital admissions for acute abdominal pain, with 1-3% requiring removal of the gallbladder. The progressively increasing prevalence of gallbladder disease represents a major health burden, with direct plus indirect costs of approximately \.2 billion annually in the United States. In this context, the timely and efficient diagnosis of cholecystitis is of paramount importance, as length of hospital stay and multiple diagnostic tests for each patient are major contributors to the cost of treating gallbladder disease. Currently, abdominal ultrasound is the study of choice for diagnosing cholelithiasis, while HIDA scan is the study of choice for diagnosing cholecystitis. However, our study had the goal of determining whether patients with suspected cholecystitis on ultrasound benefitted from subsequently having a HIDA scan to clarify diagnosis. Methods: We retrospectively reviewed patients evaluated for presumed cholecystitis between 2007 and 2010, through the Emergency Department of our 600-bed academic medical center. We identified 154 patients who underwent abdominal ultrasound and HIDA scan, and proceeded to cholecystectomy on the same admission. Ultrasound results were compared to those of HIDA scan. The pathology findings of the cholecystectomy were used as the gold standard for the diagnosis of cholecystitis. Results: Statistical analysis revealed that abdominal ultrasound had 47% sensitivity for cholecystitis, with a positive predictive value of 96%. HIDA scan had a sensitivity of 62% for cholecystitis, with a positive predictive value of 96%. Conclusions: Our study confirmed previous findings related to the superior sensitivity of HIDA scan in diagnosing cholecystitis. However, we also showed that both ultrasound and HIDA scan have a positive predictive value of 96%, suggesting that a HIDA scan would not provide additional diagnostic benefit in a patient with sonographic findings consistent with cholecystitis. Based on these results and the importance of early surgical intervention for improved outcomes in patients with cholecystitis, especially when focusing on efficient resource utilization, it would be advisable to proceed to cholecystectomy immediately following positive ultrasound findings without the delay or expense of a confirmatory HIDA scan.