IOTW 8/31/2020

57F p/w epigastric pain with RUQ ttp on exam

  1. What is the name of this ultrasound finding?
  • Wall Echo Shadow (WES) sign

2. What is the etiology of this finding?

  • Large gallstone or numerous smaller gallstones filling the lumen of a contracted gallbladder

3. What are three things that should be on
your differential when you see this?

  • Air-filled bowel loop, porcelain gallbladder, emphysematous cholecystitis

4. Is this finding a sign of cholecystitis?

  • No. The five sonographic signs of cholecystitis are: stone impaction in neck, anterior wall thickening, pericholecystic fluid, gallbladder hydrops, and sonographic Murphy sign

WES sign is non-specific, so if acute cholecystitis is suspected,
CT or HIDA scan may be appropriate

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