Classical WES sign

Case contributed by Dr Rahul Chivate

Presentation

C/O Pain in right upper quadrant with fever.

Patient Data

Age: 45 years
Gender: Female
Modality: Ultrasound

Echogenic area in gallbladder fossa represents gall  bladder with multiple small gallstones. Posterior acoustic shadowing is present beneath the gallstones. Thin rim of hypoechoic area between two echogenic lining could represent bile between gall bladder wall and calculi.

Case Discussion

WES sign represents well defined echogenic gall bladder wall (W), echoes (E) from gallstones beneath gall bladder wall and prominent posterior acoustic shadowing (S). Hypoechoic area beneath echogenic bladder wall and calculi represent interpostioned bile.  This sign is sufficient for diagnosis of Cholelithiasis.

This sign suggests large gallstone or multiple small stones filling the entire gall bladder lumen. If WES sign is not recognized, an gall bladder may be misinterpreted as bowel loop.

Pitfalls are- Calcification of gall bladder wall as in porcelain gallbladder and collapsed gallbladder and portion of duodenum appears echogenic with posterior shadowing.

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Case Information

rID: 24745
Case created: 9th Sep 2013
Last edited: 29th Feb 2016
Inclusion in quiz mode: Included

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