57F p/w epigastric pain with RUQ ttp on exam
- 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
Emergency Medicine Residency Program 