A woman of 40 presents with intermittent RUQ pain and nausea. You try to find her gallbladder.
Describe and interpret these scans
Image 1: Fanning through the long axis of the gallbladder fossa.
This lovely clip shows how difficult it can be to differentiate gas within the lumen of bowel from a gallbladder packed with tiny stones. The clip shows the liver edge covering gas filled bowel and then fans to show the wall-echo-shadow pattern typical of a gallbladder tightly packed with small stones.
Cholelithiasis with the WES sign
Air and stones can appear similar on ultrasound.
- Air casts a dirty grey shadow.
- Stone casts a darker cleaner acoustic shadow.
Wall-echo-shadow (WES) sign: first there is the echogenic gallbladder wall, then a very thin rim of hypoechoic bile, then the echogenic surface may by innumerable small gallstones, and finally the dark and clean acoustic shadow.