Wall-echo-shadow sign (ultrasound)

Last revised by Dr Jeremy Jones on 20 Sep 2021

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

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Cases and figures

  • Case 1
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  • Case 2
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  • Case 3
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