Wall-echo-shadow sign (ultrasound)
Citation, DOI, disclosures and article data
Citation:
Shin J, Murphy A, Jones J, et al. Wall-echo-shadow sign (ultrasound). Reference article, Radiopaedia.org (Accessed on 09 Mar 2025) https://doi.org/10.53347/rID-21822
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rID:
21822
Article created:
20 Feb 2013,
James Shin
Disclosures:
At the time the article was created James Shin had no recorded disclosures.
View James Shin's current disclosures
Last revised:
Disclosures:
At the time the article was last revised Andrew Murphy had no financial relationships to ineligible companies to disclose.
View Andrew Murphy's current disclosures
Revisions:
14 times, by
11 contributors -
see full revision history and disclosures
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Synonyms:
- WES sign
- Wall echo shadow sign
- Double-arc-shadow sign
The wall-echo-shadow sign (also known as WES sign) is an ultrasonographic finding within the gallbladder fossa referring to the appearance of a "wall-echo-shadow":
- a curvilinear hyperechogenic line representing the gallbladder wall
- a thin hypoechoic space representing a small amount of bile
- a curvilinear hyperechogenic line representing the near surface of gallstone(s)
- and acoustic shadowing distal to the surface of the gallstone(s)
The sign suggests either a large gallstone or multiple small gallstones filling the lumen of a contracted or incompletely visualized gallbladder. Recognizing this finding helps to avoid misinterpretation of a stone-filled gallbladder as a loop of bowel 3.
Differential diagnosis
- air-filled loop of bowel
- porcelain gallbladder: lacks the thin hypoechoic bile space between the wall and gallstone, as seen in the wall-echo-shadow sign
- emphysematous cholecystitis
References
- 1. Rybicki F. The WES Sign. Radiology. 2000;214(3):881-2. doi:10.1148/radiology.214.3.r00mr38881
- 2. MacDonald F, Cooperberg P, Cohen M. The WES Triad — A Specific Sonographic Sign of Gallstones in the Contracted Gallbladder. Gastrointest Radiol. 1981;6(1):39-41. doi:10.1007/bf01890219
- 3. William E. Brant, Clyde A. Helms. The Brant and Helms Solution: Fundamentals of Diagnostic Radiology, Third Edition, Plus Integrated Content Website (4 Vol. Set). (2006) ISBN: 0781765188
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