Objective: To analyze the ultrasound imaging features of patients with calculous cholecystitis and the diagnostic value of ultrasound imaging on calculous cholecystitis. Methods: The clinical data of 60 patients with suspected calculous cholecystitis admitted to the hospital from November 2021 to November 2024 were retrospectively analyzed. All patients received ultrasound examination. The pathological diagnosis was used as the gold standard to describe the ultrasound imaging features of patients with calculous cholecystitis. The diagnostic value of ultrasound detection on calculous cholecystitis was analyzed. Results: Ultrasound manifestations of acute calculous cholecystitis revealed gallbladder enlargement or swelling, diffuse thickening of gallbladder wall, poor intracystic sound transmission, positive ultrasound Murphy’ s sign. Ultrasound manifestations of chronic calculous cholecystitis showed no obvious change or slight enlargement of gallbladder, thickened and rough gallbladder wall, enhanced echo, intracystic sound transmission, and negative Murphy’ s sign. The accuracy of ultrasound detection in the diagnosis of calculous cholecystitis was 93.33%, with Kappa value of 0.712. Conclusion: Gallbladder enlargement, gallbladder wall thickening, fluid accumulation around the gallbladder and strong echo mass with acoustic shadow are ultrasound imaging features of patients with calculous cholecystitis. Ultrasound detection has good diagnostic value on calculous cholecystitis.